End-of-Life Care Provided to Patients and Families Who Die Shortly After Arriving at the Emergency Room: A Scoping Review

TL;DR

This study reviews end-of-life care in emergency rooms for patients who die shortly after arrival, highlighting challenges and ways to improve care quality.

Contribution

The study provides a scoping review of end-of-life care practices, barriers, and facilitators in ERs for patients who die shortly after admission.

Findings

End-of-life care in ERs focuses on symptom relief and life-saving interventions.

Barriers include ER environment, communication challenges, and unclear patient preferences.

Facilitators include nurse support and environmental improvements for patient comfort.

Abstract

With the global aging population and rising mortality rates, more deaths are occurring in emergency rooms (ERs). Although ERs are primarily designed for acute treatment and resuscitation, they are also settings for end-of-life care. However, delivering high-quality end-of-life care in the ER is challenging owing to sudden deaths, limited resources, time constraints, and often unclear patient preferences. While end-of-life care aims to facilitate a “good death,” little is known about care practices for patients who die shortly after ER arrival. In this study, we aimed to clarify the content, barriers, and facilitators of end-of-life care in the ER. We systematically searched PubMed, Cumulative Index in Nursing and Allied Health Literature (CINAHL), and Ichushi-Web for studies published until November 22, 2024, using keywords related to ERs, death, and end-of-life care. The inclusion criteria included studies involving patients who died in the ER (without intensive care unit (ICU) admission or transfer) and end-of-life care provided in the ER setting, including perspectives from patients and families. Findings were integrated using a narrative synthesis approach, based on meaning-driven coding and categorization. Rather than formal thematic analysis, synthesis was guided by meaning-based classification and consensus among authors. A total of 3,614 studies were screened. Of 125 identified studies, 46 met the inclusion criteria. End-of-life care in ERs primarily involves symptom relief and optimal life-saving interventions. Barriers included the physical environment of the ER, healthcare professionals’ attitudes and communication challenges, and the complexities of patient-family dynamics. Facilitators included ER nurse support and environmental improvements that promoted patient comfort and privacy. This review highlights the need for improved understanding and delivery of end-of-life care in the ER settings, particularly for patients who die shortly after arrival. Future studies should validate assessment tools, develop educational programs for ER staff and families, and evaluate the impact of staffing levels on care quality. Limitations include variability in emergency care systems across countries and the lack of analysis on cultural or religious factors, which may affect the generalizability of the findings.

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