Palliatiiviset potilaat ja ennakoivat hoitosuunnitelmat erikoissairaanhoidon päivystyksessä

The purpose of this study is to generate new information about patients in palliative care and ACPs. The aim of this study is to increase understanding of the use of registry data in monitoring specialized health care emergency visits and ACP. A data-based cross-sectional descriptive study design study was conducted in a Finnish well-being region in emergency department. Data were retrospectively collected from the region’s reporting system between 01/2018-08/2023. The data included patient demographics, diagnoses coded under ICD-10 Z51.5 (palliative care), modes of arrival at the ED, reasons for visits, and the existence of ACPs using the procedure code WPA10. Data was analyzed using descriptive analysis method. Between 01/2018-08/2023, a total of 178,619 patients visited the specialized emergency services in the health region, with 292,093 visits recorded. During the study period, 161 palliative patients visited the ED 177 times. The median age of these patients was 75 years. Over half of the patients arrived by ambulance. The most common primary diagnoses for palliative patients were cancer-related (C-diagnoses), and circulatory system diseases (I-diagnoses). The most common reasons for emergency visits among palliative patients included general weakness (A04) and shortness of breath (R02), with 103 visits lacking a recorded reason. Regarding advanced care planning (WPA10 code), 180 individuals had both a Z51.5 diagnosis and an advanced care plan during the study period. Of these, approximately 21% visited the emergency department. This study emphasizes the importance of timely ACP documentation to potentially reduce unnecessary ED visits and improve patient-centered care. Despite an increase in documented ACPs, many palliative patients still visited the ED, indicating a need for further development in implementing effective palliative care strategies. Future research should focus on the long-term effects of ACP documentation on patient outcomes and ED utilization. The systematic documentation and utilization of ACPs are crucial in managing palliative patients' care and reducing their reliance on emergency services. This study underscores the need for continued efforts to enhance the implementation of ACPs in clinical practice.