End-of-life management protocol offered within emergency room (EMPOWER): study protocol for a multicentre study
Background Patients at their end-of-life (EOL) phase frequently visit the emergency department (ED) due to their symptoms, yet the environment and physicians in ED are not traditionally equipped or trained to provide palliative care. This multicentre study aims to measure the current quality of EOL...
Saved in:
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-04-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/4/e036598.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850106275993485312 |
|---|---|
| author | Yoko Kin Yoke Wong Rakhee Yash Pal Win Sen Kuan Ling Tiah Ranjeev Kumar Luming Shi Charles Qishi Zheng Jingping Lin Sufang Liang Uma Chandra Segara Woon Chai Yong Noreen Guek Cheng Chan Mui Teng Chua Irwani Ibrahim |
| author_facet | Yoko Kin Yoke Wong Rakhee Yash Pal Win Sen Kuan Ling Tiah Ranjeev Kumar Luming Shi Charles Qishi Zheng Jingping Lin Sufang Liang Uma Chandra Segara Woon Chai Yong Noreen Guek Cheng Chan Mui Teng Chua Irwani Ibrahim |
| author_sort | Yoko Kin Yoke Wong |
| collection | DOAJ |
| description | Background Patients at their end-of-life (EOL) phase frequently visit the emergency department (ED) due to their symptoms, yet the environment and physicians in ED are not traditionally equipped or trained to provide palliative care. This multicentre study aims to measure the current quality of EOL care in ED to identify gaps, formulate improvements and implement the improved EOL care protocol. We shall also evaluate healthcare resource utilisation and its associated costs.Methods and analysis This study employs a quasiexperimental interrupted time series design using both qualitative and quantitative methods, involving the EDs of three tertiary hospitals in Singapore, over a period of 3 years. There are five phases in this study: (1) retrospective chart reviews of patients who died within 5 days of ED attendance; (2) pilot phase to validate the CODE questionnaire in the local context; (3) preimplementation phase; (4) focus group discussions (FGDs); and (5) postimplementation phase. In the prospective cohort, patients who are actively dying or have high likelihood of mortality this admission, and whose goal of care is palliation, will be eligible for inclusion. At least 140 patients will be recruited for each preimplementation and postimplementation phase. There will be face-to-face interviews with patients’ family members, review of medical records and self-administered staff survey to evaluate existing knowledge and confidence. The FGDs will involve hospital and community healthcare providers. Data obtained from the retrospective cohort, preimplementation phase and FGDs will be used to guide prospective improvement and protocol changes. Patient, family and staff relevant outcomes from these changes will be measured using time series regression.Ethics and dissemination The study protocol has been reviewed and ethics approval obtained from the National Healthcare Group Domain Specific Review Board, Singapore. The results from this study will be actively disseminated through manuscript publications and conference presentations.Trial registration number NCT03906747. |
| format | Article |
| id | doaj-art-bb64c10319e04624baec014fce6c0b4e |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-bb64c10319e04624baec014fce6c0b4e2025-08-20T02:38:52ZengBMJ Publishing GroupBMJ Open2044-60552020-04-0110410.1136/bmjopen-2019-036598End-of-life management protocol offered within emergency room (EMPOWER): study protocol for a multicentre studyYoko Kin Yoke Wong0Rakhee Yash Pal1Win Sen Kuan2Ling Tiah3Ranjeev Kumar4Luming Shi5Charles Qishi Zheng6Jingping Lin7Sufang Liang8Uma Chandra Segara9Woon Chai Yong10Noreen Guek Cheng Chan11Mui Teng Chua12Irwani Ibrahim13Singapore Clinical Research Institute, SingaporeEmergency Medicine Department, National University Hospital, National University Health System, SingaporeEmergency Medicine, National University Hospital, SingaporeAccident & Emergency Medicine, Changi General Hospital, SingaporeAcute and Emergency Care Centre, Khoo Teck Puat Hospital, SingaporeSingapore Clinical Research Institute, SingaporeSingapore Clinical Research Institute, SingaporeEmergency Medicine Department, National University Hospital, National University Health System, SingaporeEmergency Medicine Department, National University Hospital, National University Health System, SingaporeEmergency Medicine Department, National University Hospital, National University Health System, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SingaporeEmergency Medicine Department, National University Hospital, National University Health System, SingaporeEmergency Medicine Department, National University Hospital, National University Health System, SingaporeBackground Patients at their end-of-life (EOL) phase frequently visit the emergency department (ED) due to their symptoms, yet the environment and physicians in ED are not traditionally equipped or trained to provide palliative care. This multicentre study aims to measure the current quality of EOL care in ED to identify gaps, formulate improvements and implement the improved EOL care protocol. We shall also evaluate healthcare resource utilisation and its associated costs.Methods and analysis This study employs a quasiexperimental interrupted time series design using both qualitative and quantitative methods, involving the EDs of three tertiary hospitals in Singapore, over a period of 3 years. There are five phases in this study: (1) retrospective chart reviews of patients who died within 5 days of ED attendance; (2) pilot phase to validate the CODE questionnaire in the local context; (3) preimplementation phase; (4) focus group discussions (FGDs); and (5) postimplementation phase. In the prospective cohort, patients who are actively dying or have high likelihood of mortality this admission, and whose goal of care is palliation, will be eligible for inclusion. At least 140 patients will be recruited for each preimplementation and postimplementation phase. There will be face-to-face interviews with patients’ family members, review of medical records and self-administered staff survey to evaluate existing knowledge and confidence. The FGDs will involve hospital and community healthcare providers. Data obtained from the retrospective cohort, preimplementation phase and FGDs will be used to guide prospective improvement and protocol changes. Patient, family and staff relevant outcomes from these changes will be measured using time series regression.Ethics and dissemination The study protocol has been reviewed and ethics approval obtained from the National Healthcare Group Domain Specific Review Board, Singapore. The results from this study will be actively disseminated through manuscript publications and conference presentations.Trial registration number NCT03906747.https://bmjopen.bmj.com/content/10/4/e036598.full |
| spellingShingle | Yoko Kin Yoke Wong Rakhee Yash Pal Win Sen Kuan Ling Tiah Ranjeev Kumar Luming Shi Charles Qishi Zheng Jingping Lin Sufang Liang Uma Chandra Segara Woon Chai Yong Noreen Guek Cheng Chan Mui Teng Chua Irwani Ibrahim End-of-life management protocol offered within emergency room (EMPOWER): study protocol for a multicentre study BMJ Open |
| title | End-of-life management protocol offered within emergency room (EMPOWER): study protocol for a multicentre study |
| title_full | End-of-life management protocol offered within emergency room (EMPOWER): study protocol for a multicentre study |
| title_fullStr | End-of-life management protocol offered within emergency room (EMPOWER): study protocol for a multicentre study |
| title_full_unstemmed | End-of-life management protocol offered within emergency room (EMPOWER): study protocol for a multicentre study |
| title_short | End-of-life management protocol offered within emergency room (EMPOWER): study protocol for a multicentre study |
| title_sort | end of life management protocol offered within emergency room empower study protocol for a multicentre study |
| url | https://bmjopen.bmj.com/content/10/4/e036598.full |
| work_keys_str_mv | AT yokokinyokewong endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT rakheeyashpal endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT winsenkuan endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT lingtiah endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT ranjeevkumar endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT lumingshi endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT charlesqishizheng endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT jingpinglin endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT sufangliang endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT umachandrasegara endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT woonchaiyong endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT noreenguekchengchan endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT muitengchua endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy AT irwaniibrahim endoflifemanagementprotocolofferedwithinemergencyroomempowerstudyprotocolforamulticentrestudy |