Imagine your loved one is taken to hospital in an ambulance after falling at work and hitting their head. Someone from work has phoned to tell you what happened and said not to worry too much because although they lost consciousness, your loved one was awake by the time the ambulance arrived.

You arrive at the hospital soon after and ask at triage to see your loved one. A staff member takes you to a waiting room and tells you someone will be with you shortly to let you know what is happening. A while later a doctor comes into the room and tells you that your loved one has suffered a life-threatening brain haemorrhage and will not survive.

The sudden and unexpected death of a loved one is very traumatic, and unfortunately unexpected deaths can often occur in the emergency department setting following all kinds of illness and injuries; including road accidents and other trauma, stroke, heart attack, and pre-existing illness such as cancer. The number of people presenting to and dying in emergency departments is steadily increasing as our population ages. It is therefore vital to make sure that, once all life-saving options have been exhausted, the care provided to dying patients and their families is the best possible care available. An end-of-life experience will resonate with families for many years. Caring for dying patients is therefore important and urgent because we only have one chance to get it right.

Caring for people who die in an emergency department setting can be very challenging and complex for nurses and doctors. Emergency departments are very busy and often overcrowded. They are designed and staffed in a way that facilitates rapid assessment, and stabilisation and treatment of patients prior to transferring them to another hospital, admitting them to the wards, or discharging them home. The very nature of the busy and often chaotic ED setting means that staff face many barriers and may not always be adequately equipped to care for dying patients and their families.

We know that the quality of care received at the end-of-life can either positively or negatively impact the grieving process for surviving family members. High quality care can help minimise grief and suffering, help with closure, and reduce the incidence of post-traumatic stress. On the other hand, ineffective care at the end-of-life can lead to unresolved grief among family members, and this can cause many problems in the following weeks, months and even years after the death has occurred. Problems such as high blood pressure, chronic insomnia, depressive symptoms, increased susceptibility to illness, and anxiety.

While some patients and their families receive excellent end-of-life care in the emergency department setting - unfortunately some do not. Our previous research tells us that nurses and doctors believe the quality of care provided in the emergency department for dying patients and their families is not as good as it needs to be. Some of the recommendations clinicians have made for improving end-of-life care in the emergency department include; enhancing clinician communication skills, providing better explanations, determining patients’ end of life wishes as soon as possible, avoiding futile tests and treatments, providing better pain and symptom control, allowing family to be with their loved one if they wish during resuscitation attempts, spending more time with dying patients and their families, and providing bereavement support to families during the dying process and after the patient has died.

Until now, there has been very little research looking at the experiences of family members who have had a loved one die suddenly and expectantly in an emergency department setting. It is important that family members are offered the opportunity to share their experiences and contribute to recommendations for improved care.

Flinders University researchers (led by Dr Tracey Giles) are currently conducting a study with family members about their experiences of having a loved one die suddenly and unexpectantly in a South Australian emergency department.

The study will help us to identify the practical and emotional care and support that family members would like to receive when a loved one is dying or has died in the emergency department setting and to establish what is working well already and areas of care that need improvement.

If you are 18 years or older, and one of your family members or friends or loved ones had died suddenly in an emergency department setting in the past 10 years, then we would very much like to hear about your experience.

If you are interested in talking part or in finding out more about the study, you can contact Dr Tracey Giles at Flinders University on 08 8201 3481 or by email at tracey.giles@flinders.edu.au any time before October 31st 2018.






Dr Tracey Giles, Head of Teaching Section (Nursing), Flinders University