[Palliative care in an acute care setting at Kumamoto Regional Medical Center]

The Japanese government promotes allowing patients in palliative care to choose where they wish to end their lives. Emergency hospital admissions are inevitable for those cared at home. There are not enough cancer centers in Japan with palliative care facilities and hospices to admit these patients without prior consultation.

We examined outcomes and characteristics of patients receiving palliative care who were transported by ambulance to our hospital.

From April 2007 to March 2010, 58 patients under palliative care came to our emergency department by ambulance. Eight of the 58 (14%) were admitted between midnight and 8 am and 21 (36%) on Saturdays or Sundays. We were consulted for 19 patients (32%) within one week and saw 14 of these on the day they were admitted. Chief complaints were disturbed consciousness (31%), dyspnea (28%), pain (14%) and general fatigue (7%). Fifty patients (86%) came directly from their homes and the others from another hospital. Thirteen patients (22%) died within 48 hours, and 8 (14%) were discharged after their symptoms were treated. Thirty-three (57%) patients died and 4 (7%) were discharged within ten days.

We admitted patients under palliative care into the acute care setting to Kumamoto Regional Medical Center any time.