Better care for the dying in NUH’s emergency ward

NUH doctor says the hospital’s emergency department is seeing more terminally ill patients, for whom aggressive interventions may not be the way to go.
By Neo Chai Chin, Channel NewsAsia, 29 Jul 2014

Providing better quality of life and comfort to dying patients and their families within the fast-paced setting of a hospital’s emergency department might seem like a paradox, but that is what an emergency physician at the National University Hospital (NUH) has set out to do.

Emergency departments are traditionally focused on life-saving and aggressive resuscitative care. But with the ageing population here, the department is seeing more terminally ill patients, for whom aggressive life-saving interventions may not be the way to go, said Dr Rakhee Yash Pal, who is spearheading NUH’s palliative care efforts at its emergency department, believed to be a first for public hospitals here.

Of the 133,000 attendances last year at its emergency department, 414 died there. Fifty-five per cent of the deaths were of patients aged 65 and above, up from about 50 per cent in 2011.

The NUH has a palliative care team that can be deployed to various units in the hospital, but some emergency patients have only hours to live. The earlier the goals of care and treatment options for patients are determined, the more comfortable they will be, said Dr Yash Pal. For instance, a patient may wish to not die with tubes in him.

As part of its new palliative care initiatives, an emergency team member will set out to contact family members or check a patient’s records while the rest of the team is stabilising a patient with high risk of death. Previously, speaking to the family would come only after stabilising the patient.

Studies in the United Kingdom have shown palliative care needs are common among older people who die in emergency departments, Dr Yash Pal said. Palliative care does not hasten death, but relieves suffering of dying patients, especially those with serious chronic illnesses such as organ failure.

A workgroup consisting of four doctors and four nurses was formed in May, and protocols will be implemented in areas such as end-of-life symptom management and nursing guidelines. The aim is to fully train the 30 NUH emergency department doctors by the end of next year, with training also conducted for nurses.

Last month, the department began offering dying patients a private room called the Quiet Room, which allows more relatives to be by their side. Two more Quiet Rooms are in the pipeline, said Dr Yash Pal, whose experience of caring for her late grandmother led her to seek improvements to the system.

The room provided extra comfort to a patient, Shamsuddin Shaul Hameed, earlier this month before he died. His cousin and main caregiver, Ms Mumina Jahabar, 46, said the family, including his wife and older daughter, spent time in the room with Shamsuddin, 54, who did not recover after major surgery for pancreatic cancer.

Dr Yash Pal said no extra charge is levied for use of the Quiet Room. Asked if more manpower will be needed to implement palliative care at the department, she said not all patients require this service. And with the right communication skills, doctors can sometimes derive what they need to know in family conferences in 15 minutes.