Pitfalls
Assuming palliative care discussions are more appropriately led by inpatient teams. Emergency medicine clinicians can both add to a dying patients quality of life and help prevent unnecessary treatments being started or escalated.
Being too precise when discussing prognosis or time frames. Diagnosing dying is hard, as is estimating a patients trajectory in the final hours of life. If your precise projections are incorrect, it can add to the distress of family members and undermine their confidence in the care you are providing.
Prognosticating perceived devastating brain injuries is particularly difficult and prone to error. It is important not to commence a purely palliative approach in these patients until 24-72 hours has elapsed since the injury, regardless of the results of initial neurosurgical consultation26.
Failing to review a patients advance care planning or appreciate the legal status of the various documents you may be given to review. An advance statement is not legally binding, whereas an advance decision to refuse treatment or a valid lasting power of attorney for health and welfare are.
Delaying prescribing anticipatory medication. Sedation and opioids dont shorten life if used at the minimum levels to relieve distress or uncontrolled pain, with dosages adjusted as needed.
Neglecting legal responsibilities following any death in the emergency department, such as involving the police, coroner or procurator fiscal, regardless of whether the patient was receiving palliative care or not.