Sir, – I wish to clarify remarks attributed to me in your Editorial on Saturday (June 30th) and in last Thursday’s Irish Times (June 28th) with regard to end-of-life care in emergency departments.
A clinician’s primary concern is always the quality of patient care they provide. The experiences of patients and their families are critical determinants of quality in healthcare and are at the core of end-of-life care. Research presented at the International Conference on Emergency Medicine 2012 in Dublin last week indicated that some patients need emergency department care in their last months of life and that the best care is provided by having the patient at the centre of all decision making, through effective communication between patients and clinicians, advance planning and the early involvement of palliative care teams.
Patients who do not need emergency care should have end-of-life care provided for them in the setting of their choice, whether at home, in a nursing home or hospice. Any economic considerations should be framed in terms of value, ie delivering the best patient outcomes and experiences for the health care costs involved – and the focus must always be on the patient and the quality of care they receive.
I would like to commend the ongoing work of the Irish Hospice Foundation’s Hospice Friendly Hospitals programme that is improving end-of-life care in emergency departments and acute hospitals in Ireland.
The highest end-of-life care is achievable through a partnership between patients, their families and healthcare providers. Advance planning ensures that the patient is always the most influential person in that partnership. – Yours, etc,