Palliative care interventions in the emergency department: a focus group study of healthcare professionals’ views

Background: Despite the national priority to reduce emergency admissions at the EOL, people with life-limiting illnesses are increasingly accessing the ED. There are however concerns that emergency care for patients with life-limiting illness is inadequate. Understanding staff perspectives of barriers to quality care provision at the EOL in the ED is fundamental in order to recommend improvements for service provision. Methods: Three focus groups were conducted using semi-structured questions, based on the results of the literature review in the initial phase of the project. Purposive sampling was used as participants needed prior knowledge of palliative care or experience in working in the ED. Number of participants in focus groups ranged from five to nine due to workload demands within the ED on day of focus group. Data analysis was undertaken using Ritchie and Spencer’s (1994) Framework analysis. Results: ED staff identified barriers in the ED that hinder the provision of EOLC. They recommended interventions which they felt could improve care provision; patient pathway, universal documentation and improving education. Overall, participants felt the ED environment was inappropriate to provide EOLC suggesting that the primary function of the ED is not conducive to palliative care. Conclusion: The ED culture does not account for EOLC presenting barriers for patients who attend for palliative emergencies. Within the UK very little attention has been paid to interventions improving EOLC in the ED. Results highlight that interventions to improve EOLC need to consider the organisational culture that exists in the emergency setting; important when considering service provision and improving healthcare