What Are Staff Perceptions About Their Current Use of Emergency Departments for Long-Term Care Residents at End of Life?

Sharon Kaasalainen, Tamara Sussman, Pamela Durepos, Lynn McCleary, Jenny Ploeg, Genevieve Thompson, SPA-LTC Team, Sharon Kaasalainen, Tamara Sussman, Pamela Durepos, Lynn McCleary, Jenny Ploeg, Genevieve Thompson, SPA-LTC Team

Abstract

The goal of this study was to examine current rates of resident deaths, Emergency Department (ED) use within the last year of life, and hospital deaths for long-term care (LTC) residents. Using a mixed-methods approach, we compared these rates across four LTC homes in Ontario, Canada, and explored potential explanations of variations across homes to stimulate staff reflections and improve performance based on a quality improvement approach. Chart audits revealed that 59% of residents across sites visited EDs during the last month of life and 26% of resident deaths occurred in hospital. Staff expressed surprise at the amount of hospital use during end of life (EOL). Reflections suggested that clinical expertise, comfort with EOL communication, clinical resources (i.e., equipment), and family availability for EOL decision making could all affect nondesirable hospital transfers at EOL. Staff appeared motivated to address these areas of practice following this reflective process.

Keywords: hospital use; long-term care; palliative care.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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