Palliative care patients' use of emergency departments

To compare attendances of Maori with non-Maori palliative care patients at Emergency Departments (ED) and the outcome of their visits.

This was an observational study using record linkage. The study population was Waikato palliative care patients registered in a 12-month period, aged over 20 years. For each patient we recorded from the hospital records their age, gender, ethnicity, domicile (Hamilton or other), hospital visited and number of visits to the emergency department in the study period. We compared likelihood of attendance at ED and also looked at reasons for the visits and the outcome--including admit to hospital or place of discharge

1185 palliative care patients were identified from the palliative care register. There were 645 men (54.4%), 197 Maori (16.6%) and 18 Pacific (1.5%). The mean age overall was 70.8 years and mean length of time on the register during the year of interest was 120.7 (median 66) days. 449 (37.9%) of the study population visited ED at least once. A multivariate analysis revealed that men visited ED more than women (Odds Ratios [OR] 1.6, p=0.001) and women with a gynaecological cancer visited ED more often than other palliative care conditions (OR 3.3, p<0.001). No other factor including ethnicity was associated with the risk of visiting ED.

This study has helped quantify the characteristics of palliative care patients utilising ED in a relatively rural population with a high proportion of Maori. It has shown that a significant proportion of palliative care patients will attend ED, that men with palliative care needs are more likely to attend ED but Maori are not more likely to utilise the services. We believe that New Zealand hospitals should consider the role of their ED in the management of palliative care patients.