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Identifier 000431615
Title Η συμμόρφωση των ελληνικών τμημάτων επειγόντων περιστατικών στις οδηγίες της EUSEM για ζητήματα που αφορούν την φροντίδα στο τέλος της ζωής του ασθενή
Alternative Title The compliance of Greek Emergency Departments with the EUSEM Guidelines on end of life care issues
Author Μαρκάκης, Εμμανουήλ-Φανούριος
Thesis advisor Νότας, Γεώργιος
Reviewer Αγγουριδάκης, Παναγιώτης
Ηλία, Σταυρούλα
Abstract Introduction : The concept of end of life (EoL) care, which is care offered to patients during the end of their lives, includes a combination of medical, psychological, social, emotional and spiritual care, both for the patient and those close to him. Compared to previous decades, it is more common nowadays for patients with acute diseases capable of producing death, or patients with the progression of a terminal illness, to visit an Emergency Department (ED) for care close to their EoL. EuSEM has recognized the importance of this issue by developing specific guidelines for EoL care in the ED. It is important to understand the current weaknesses of Greek EDs in EoL care in order to organize appropriate and more humane healthcare services. Purpose : The purpose of this study was to evaluate the compliance of Greek EDs with EUSEM EoL care guidelines. Methods : A questionnaire with 45 questions, based on the EUSEM guidelines on EoL care, was sent to either the head physician or the head nurse of all Greek hospitals with independent EDs. Pediatric, psychiatric, and other special hospitals were excluded. Results : 54 out of the 82 eligible hospitals responded to the survey (65% of all Greek hospitals, >75% population coverage). Only 20.4% of EDs reported having formal communication instructions for the staff regarding EoL issues and 22% reported having some form training in announcing a patient’s death. Although 77.8% of EDs reported that their physicians were able to identify EoL patients and in 74.1% discussions for advanced care-planning is performed, in less than 30% these discussions are formally recorded and in less than 30% “Do Not Attempt Resuscitation” (DNAR) decisions are documented. 63% of the EDs reported discharging patients with a care plan to die at their home and written discharge instructions. In more than 80% of the EDs a senior physician is responsible for EoL issues, EoL decisions (if nobody else can take them for the patient) and the announcement of a death. However, only in a minority of Greek EDs family is included in EoL decisions or discussions. 78% of EDs reported ignorance for the legal status of DNAR orders in Greece and only 16% had access to legal advice. In most cases (90%) DNAR is decided by a senior specialist, but in 37% CPR is continued if the family insists, and in 25% CPR is performed even against expressed patient wishes. 61% provide palliative care but only 14% have an organized checklist. Most Greek EDs do not have special rooms for the family during EoL situations but 62% have facilities for their cultural and spiritual needs. Finally, in 61% of Greek EDs, staff members are encouraged to talk about EoL events. Conclusion: Greek EDs should further improve EoL care. Our study shows that there are several improvements that could be made in communication, discussion/decision recording, DNAR management, dedicated use of space and support of ED staff on legal and stress-related EoL issues.
Language Greek
Subject Τμήμα επειγόντων περιστατικών
Issue date 2020-08-05
Collection   Faculty/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
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