Ceilings of treatment and treatment adequacy in the Emergency department – retropective Study

Keywords: Ceilings of treatment, palliative care, Emergency Department

Abstract

Introduction: the Emergency Department is in a constant state of antagonism due to its nature towards the acute pathology, and quality of palliative care. Our study aims to assess whether the definition of a therapeutic ceiling leads to differences in the adequacy of the diagnostic methods and therapy instituted.
Material and methods: retrospective descriptive monocentric analysis of patients who died the first 6 months of 2018 in the emergency department of Hospital do Espírito Santo de Évora.
Results: the three groups of patients were compared, one without any therapeutic ceiling defined, with the group in which they started palliative measures and the group in which the Decision to Not Resuscitate was made. There were no significant differences between ages, place of residence and comorbidities except for dementia (p=0.006), but there is a difference in the degree of dependence on activities of daily living (p<0.001). It was found that there are no differences between the number or type of complementary diagnostic tests, but there are some differences in the therapy instituted since in the group of patients in palliative care, therapy with morphine (p<0.001), butylscopolamine (p=0.001) and paracetamol (p=0.004) was more frequent. Invasive ventilation only occurred in the group of patients without therapeutic ceiling (p<0.001), while oxygen therapy was more frequent in Decision to Not Resuscitate or in palliative care groups (p<0.001). 
Discussion and conclusion: the doctors of the emergency department recognize that their patients are at the end of their lives, partially adapting the therapy to control symptoms, pain and secretions. 

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Author Biographies

Sandra Ganchinho Lucas, Hospital do Espírito Santo de Évora (HESE), Serviço de Medicina I, Évora, Portugal.

Mestre em Medicina pela Faculdade de Ciências Médicas da Universidade Nova de Lisboa, em Lisboa, Portugal. Interna de Medicina Interna no Hospital do Espírito Santo de Évora, em Évora, Portugal.

Filipe Jorge Pencas Alfaiate, Hospital do Espírito Santo de Évora (HESE), Serviço de Medicina I, Évora, Portugal.

Mestre em Medicina pela Faculdade de Medicina da Universidade de Coimbra, em Coimbra, Portugal. Interno de Medicina Interna no Hospital do Espírito Santo de Évora, em Évora, Portugal.

Inês Vieira Santos, Hospital do Espírito Santo de Évora (HESE), Departamento de Medicina, Évora, Portugal.

Mestre em Medicina pela faculdade de Ciências Médicas da Universidade Nova de Lisboa, em Lisboa, Portugal. Assistente de Medicina Interna no Hospital do Espírito Santo de Évora, em Évora, Portugal.

Ireneia Lino, Hospital do Espírito Santo de Évora (HESE), Unidade de Hospitalização Domiciliária, Évora, Portugal.

Licenciada em Medicina pela Faculdade de Medicina de Lisboa, em Lisboa, Portugal. Assistente Graduada de Medicina Interna; diretora do [email protected] – Unidade de Hospitalização Domiciliária (UHDP) e Unidade Médica de Dia (UMD), em Évora, Portugal.

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Published
2022-09-22
How to Cite
Lucas, S. G., Alfaiate, F. J. P., Santos, I. V., & Lino, I. (2022). Ceilings of treatment and treatment adequacy in the Emergency department – retropective Study. Scientia Medica, 32(1), e41370. https://doi.org/10.15448/1980-6108.2022.1.41370