Home emergency response team for the seriously ill palliative care patient: feasibility and effectiveness

Abstract

ObjectivesTo characterise trajectories associated with a new team organisation combining critical care and palliative care approaches at home.MethodsWe describe the pattern of an emergency response team 24/7 directed to patients with advanced illness presenting a distressing symptom at home, who wanted to stay at home and for whom hospitalisation was considered inappropriate by a shared medical decision-making process in an emergency situation. To assess preliminary impact of this Programme, we conducted a descriptive study on all consecutive patients receiving this intervention during the first year (between 6 September 2021 and 5 September 2022).ResultsAmong the 352 patients included, main advanced illnesses were cancer (41%), dementia (28%) or chronic organ failure (10%). They were critically ill with acute failures: respiratory (52%), neurological (48%) or circulatory (20%). Main distressing symptoms were breathlessness (43%) and pain (17%). Median response time from call to home-visit (IQR) was 140 (90–265) min. Median length of follow-up (IQR) was 4 (2–7) days. Main outcomes were death at home (72%), improvement (19%) or hospitalisation (9%) including three visits to emergency department (1%).ConclusionsOur study supports that shared decision-making process and urgent care at home are feasible and might prevent undesired hospitalisations.