Emergency Department Use in the Last 90 Days of Life: A Retrospective Audit Regression Analysis

Abstract

ObjectiveTo examine patterns of emergency department (ED) presentation and emergency hospital admission in the last 90 days of life for residents of New South Wales, Australia.MethodsA retrospective audit of electronic clinical records. Descriptive statistics report patterns of ED presentation and emergency hospital admission in the last 90 days of life, and symptom drivers of ED presentation. Logistic regression identifies factors associated with low versus high rates of ED presentation and emergency admission.Results2869 ED presentations are included across 1730 decedents. 80% of ED visits led to admission. 92% of people had at least 1 ED presentation in the final 90 days of life, with 18% having 3 or more. 86% of people had at least 1 emergency admission, with 9.5% having 3 or more. Odds of high ED use and high admissions were increased for people with cancer and those under 70 years. ED visits were long and often involved multiple investigations, but a small number of patients required no investigations. Common symptom drivers of ED attendance were pain, breathlessness, and confusion/delirium.ConclusionsED presentations in the final months of life are common, and investigations are often required to assess for potentially reversible problems. Some people approaching end of life require admission to hospital via ED without the need for investigations, so may be seeking help for escalating nursing needs. Alternative models of care are needed to support escalating nursing needs at home, and funding for palliative services must keep pace with the rising demand.