• Beverley A McNamara, Lorna K Rosenwax, Kevin Murray, and David C Currow.
• Centre for Research into Disability and Society and Curtin Health Innovation Research Institute, School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia. bev.mcnamara@curtin.edu.au
• J Palliat Med. 2013 Jul 1;16(7):774-9.

BackgroundOvercrowded emergency departments (EDs) and the staff within them are often not able to address the complex physical and psychosocial needs of people at the end of life. While some studies have suggested that the ED environment should be adapted and staff trained to address this issue, there are no previous studies which have investigated whether the provision of timely palliative care services could prevent people with palliative care needs from attending EDs.ObjectiveThis study investigates whether early admission to community-based palliative care reduces ED admissions in the last 90 days of life for patients with cancer.MethodsThe study was a retrospective, cross-sectional study using death registrations and hospital morbidity data for 746 Western Australian adults who died of cancer and where palliative care may have been a viable and appropriate option for care.ResultsIn their final 90 days before death, 31.3% of decedents who had early access to palliative care and 52.0% of those who did not have early access to palliative care visited an ED (OR=2.86; 95% CI, 1.91, 4.30). Early admission to community-based palliative care reduces the use of EDs by cancer patients in the 90 days before death.ConclusionsProactive care in the form of timely community-based palliative care assists in preventing vulnerable people at the end of life from being exposed to the stressful ED environment and decreases the pressure on EDs.

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