Abstract
Background: Acute and unexpected hospitalization can cause serious distress, particularly in patients with palliative care needs. Nevertheless, the majority of neurological inpatients receiving palliative care are admitted via an emergency department.Objective: Identification of potentially avoidable causes leading to acute hospitalization of patients with neurological disorders or neurological symptoms requiring palliative care.Methods: Retrospective analysis of medical records of all patients who were admitted via the emergency department and received palliative care in a neurological ward later on (n = 130).Results: The main reasons for acute admission were epileptic seizures (22%), gait disorders (22%), disturbance of consciousness (20%), pain (17%), nutritional problems (17%), or paresis (14%). Possible therapy limitations, (non)existence of a patient decree, or healthcare proxy was documented in only 31%. Primary diagnoses were neoplastic (49%), neurodegenerative (30%), or cerebrovascular (18%) diseases. Fifty-nine percent were directly admitted to a neurological ward; 25% needed intensive care. On average, it took 24 h until the palliative care team was involved. In contrast to initially documented problems, key challenges identified by palliative care assessment were psychosocial problems. For 40% of all cases, a specialized palliative care could be organized.Conclusion: Admissions were mainly triggered by acute events. Documentation of the palliative situation and treatment limitations may help to prevent unnecessary hospitalization. Although patients present with a complex symptom burden, emergency department assessment is not able to fully address multidimensionality, especially concerning psychosocial problems. Prospective investigations should develop short screening tools to identify palliative care needs of neurological patients already in the emergency department.
Highlights
METHODSAfter cancer, neurologic conditions are the second most common diagnosis of inpatients receiving specialist palliative care [1, 2]
We studied 130 consecutive patients who had been admitted via the emergency department (ED) and subsequently received specialist palliative care consultations by a multi-professional palliative care service in the Department of Neurology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, between January 2018 and December 2019
The proportion of patients needing prompt medical care seems slightly higher in neurological patients compared to other patients with palliative care needs presenting to the ED [3, 9]
Summary
METHODSAfter cancer, neurologic conditions are the second most common diagnosis of inpatients receiving specialist palliative care [1, 2]. Like the majority of inpatients with other lifetime-reducing diseases and palliative care needs, patients with neurological diseases or complications are predominantly admitted to hospital via an emergency department (ED) [3, 4]. ED visits increase with impairment and with decreasing lifetime [6,7,8]. In many cases, they lead to long hospitalization [7, 9]. Acute and unexpected hospitalization can cause serious distress, in patients with palliative care needs. The majority of neurological inpatients receiving palliative care are admitted via an emergency department
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