A palliative care emergency is a sudden and life-threatening change in a person’s condition. In this scenario, handovers of care are particularly important to reduce risk of receiving inappropriate treatment. Planning ahead for emergencies (emergency planning) is good practice and can improve the quality and safety of care.
Emergencies may be completely unexpected but some may be anticipated during assessment. Advance care plans (ACP) can reduce the risk of poor communication and unnecessary or unwanted invasive treatments in the event of an unplanned medical event.
Planning ahead may be helpful for the following scenarios:
- when travelling away from a local area,
- a transfer from residential aged care facility to hospital,
- a transfer by ambulance, or if triple zero is called in a crisis,
- upon presentation to an emergency department,
- review in a crisis by a medical practitioner who is not familiar with the person or their management plan. 
Documentation of care preferences or the nomination of a substitute decision-maker can help to ensure that a person receives care in line with their wishes.  This is particularly important in end-of-life care where the goal is often quality of life rather than extending life. However, advance care plan completion rates remain low even for chronically ill older adults. This is attributed to poor literacy, procrastination or lack of discussion with a primary doctor. [2,4] The timing of discussions of advance care planning and who should initiate and review an ACP is still very much debated in the literature. In practice, these issues are highlighted as a barrier to effective and timely emergency care planning. [1,3,4]
Many older adults with serious and life-threatening illness present to emergency departments (EDs) with an acute deterioration in health. [9,10] One review notes that each year up to 75% of residents in aged care facilities are transferred to a hospital emergency department for acute changes in health.  Despite the intensive use of these services, older adults transferring to acute care from a RAC often have adverse clinical outcomes or die.  Strategies to address poor transition between services or engagement in palliative emergency and discharge planning are evaluated in the literature. They include early referral from ED to a palliative specialist appointment, early discharge planning, telehealth community support, electronic health records and education for caregivers on symptom management. The evidence is not strongly in support of any one intervention, all seem to show promising outcomes for quality of life for the individual and their family. [3,5-10]
Although early initiation of palliative care in the ED may contribute to less hospitalisation and help people remain at home at end-of-life, it requires adequate community support to be effective. Currently there is insufficient evidence on which to base strategies to improve palliative care in the ED or to reduce hospital admissions. Advance care planning can identify preferred responses in an emergency. [1-4,9,10] To reduce the likelihood of readmission to acute care, a number of strategies that empower individuals and their carers in symptom management seem to be effective: education to improve knowledge of care and monitoring of change, and telephone support to help with symptom management. [5,6,8]
Overall the quality of the reviews included in this synthesis was good, with most reviews considered acceptable or of high quality.
Page created 19 June 2017