Dying Matters in ED: A Framework-Based Approach to End-of-Life Conversations

Author(s): Dr Misbah Gulistan (Registrar), Dr H G Mirani (ED Consultant)

Hospital: Midlands Metropolitan University Hospital (MMUH)

Objective: We implemented a quality improvement project (QIP) to enhance end-of-life (EOL) care conversations in the Emergency Department (ED), based on Ouchi et al. (Ann Emerg Med. 2020;PMID32747084), by teaching clinicians to identify frailty, use structured communication frameworks, and access palliative resources.

Results: We delivered teaching and simulation sessions for residents and nurses on identifying seriously ill patients using the Rockwood Frailty Score, Charlson Comorbidity Index, SPICT tool, and “surprise question.” REDMAP framework guided EOL discussions.

We introduced the “Heartbeat in a Bottle” initiative, giving families a keepsake ECG.

A unified SOP is in progress, consolidating prescribing guidance, communication frameworks, and contact details. Pre-intervention surveys showed low confidence; post-intervention (PDSA 2) audit is ongoing.

Conclusions:

A structured, framework-based approach to EOL care is feasible in ED, improving confidence and supporting families compassionately. Further evaluation is underway.