End-of-Life Management Protocol Offered Within Emergency Room: a Multicentre Study (EMPOWER)
试验速览
- 阶段
- 不适用
- 入组人数
- 900
- 试验地点
- 3
- 主要终点
- Mortality rate within 48 hours of hospital admission
研究概览
简要总结
End-of-life (EOL) care has garnered increasing recognition and acceptance in the field of emergency medicine. Some emergency departments (EDs) in Singapore have instituted or plan to institute EOL care as part of the workflow. However, the EOL protocols are not standardised across all these EDs. The adherence to and quality of EOL care have not been formally measured in all institutions. Hence, gaps to improve the quality of care have yet to be determined.
The aims are to systematically measure the current quality of EOL care in three Singapore hospital EDs and identify the quality gaps; formulate interventions to address these gaps and implement the improved EOL care; and measure the improvement post-implementation. The investigators hypothesise that the current quality of EOL care in three EDs is suboptimal and the interventions planned will improve the quality of care provided.
The study team plans to conduct an interrupted time series study to detect whether the interventions have an effect significantly greater than any underlying trend over time. The quality of care indicators to be measured are timely identification of patients who require EOL care, adequacy of symptom control based on compliance to prescriptions, opportunities to discuss and develop an individualised care plan, perceived quality of care by healthcare providers and next-of-kin, and cost effectiveness. Planned interventions include refining the protocol with collaboration of content experts in palliative care, education and training of healthcare providers, and addressing specific gaps identified to improve cost effectiveness. The results of this study will form the standardisation and foundation for establishing the national benchmark for quality of EOL care in Singapore EDs.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 21 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Actively dying patient or high likelihood of mortality within 48 hours
- •Family accepts that the goals of care are provision of comfort, symptom relief and respect of dignity
- •Patient is not a candidate for cardiopulmonary resuscitation, endotracheal intubation or transfer to the intensive care unit
- •Family members want to stay by patient's bedside
- •Any of the life-limiting conditions such as chronic frailty with poor functional state and limited reversibility (Karnofski Performance Scale <40%), chronic severe illness with poor prognosis, or other deteriorating conditions and at risk of dying with complications that are not reversible, as subject to the treating clinician's judgment
排除标准
- •Vulnerable population e.g. prisoners, pregnant women
- •Patients, relatives or staff who refused to participate
- •Patients who have been recruited, or had declined participation, in the previous ED attendance(s)
结局指标
主要结局
Mortality rate within 48 hours of hospital admission
时间窗: 26 months
Proportion of patients who fits criteria of EOL who died within 48 hours (patient centred)
Satisfaction assessed by Care of the Dying Evaluation (CODE) questionnaire
时间窗: 26 months
Proportion of next-of-kin who perceived that they were adequately supported (family centred)
Satisfaction of healthcare workers with care rendered assessed by a staff survey
时间窗: 26 months
Level of satisfaction of with the overall quality of end of life care provision by doctors at ED
次要结局
- Proportion of patients in EOL pathway who have documentation of an individualised care plan, and symptoms who are prescribed with appropriate medicine(26 months)