Lightning Learning: Uncertain Recovery
The number of patients presenting to Emergency Departments in the UK is increasing.1 We are living longer, with more complex conditions. A palliative approach can be useful.
For patients with a life-limiting condition, the outcome of treatment may be uncertain. Patients will often have priorities which is not always about living longer. Patients must be involved in decisions about their care.
1 in 5 of those who die in hospital have 3+ emergency admissions in the last 90 days of life.2
Up to 30% of hospital inpatients are likely to be in their last year of life, and almost 50% of all adult deaths occur in hospital.3 Hospitals are therefore important providers of End of Life care.
Consider uncertain recovery in patients with: Suspected life expectancy of 1 year or Frailty Scores of 7, 8 and 9 or with a Palliative Diagnosis.
Where recovery is uncertain: (limited reversibility, clinical instability and a patient is at risk of dying during admission)
- Offer an HONEST and ReSPECTFUL conversation (see local guidance).
- Identify the patient’s priorities i.e. preferred place of death.
- Agree an escalation plan – what complications can you anticipate and what actions should be taken if they occur?
- Document the patient's wishes, escalation plan and complete DNACPR if appropriate.
Remember to apply the principles of the Mental Capacity Act.
- Having Difficult conversations (BMJ)
- #SimPall: Having the Conversation (EM3)
- Palliative & End of Life Care (EM3)
- Supportive & Palliative Care Indicators Tool (SPICT)