A narrative review on palliative care in the emergency department: dealing with the uncertainty of death

In the last decades emergency physicians have observed a steep increase in the emergency department (ED) admissions of palliative care patients who rely on the hospital for symptoms’ relief and management of acute exacerbations of their chronic disease. Previous studies have suggested that palliative care interventions in the ED could prevent unnecessary admissions and reduce both the length of hospitalization and costs. However, emergency medicine physicians might have limited specialistic education and resources to provide a correct management of palliative care patients and avoid futile interventions. Thus, we aim in this narrative review to provide the reader with an introduction on the principles that should guide the emergency physician in a correct approach to palliative care patients in the ED. We will explain how to deal with the intrinsic prognostic uncertainty of palliative care patients by implementing a correct ethical approach which encompasses the understanding of both appropriateness and futility of intervention; furthermore, we will present practical tools such as scores and trials.