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Title: End-of-life management protocol offered within emergency room (EMPOWER): study protocol for a multicentre study
Authors: Yash Pal, Rakhee 
Kuan, Win Sen 
Tiah, Ling
Kumar, Ranjeev
Wong, Yoko Kin Yoke
Shi, Luming 
Zheng, Charles Qishi
Lin, Jingping
Liang, Sufang
Segara, Uma Chandra
Yong, Woon Chai
Chan, Noreen Guek Cheng 
Chua, Mui Teng 
Ibrahim, Irwani 
Issue Date: Apr-2020
Publisher: BMJ
Citation: Yash Pal, Rakhee, Kuan, Win Sen, Tiah, Ling, Kumar, Ranjeev, Wong, Yoko Kin Yoke, Shi, Luming, Zheng, Charles Qishi, Lin, Jingping, Liang, Sufang, Segara, Uma Chandra, Yong, Woon Chai, Chan, Noreen Guek Cheng, Chua, Mui Teng, Ibrahim, Irwani (2020-04). End-of-life management protocol offered within emergency room (EMPOWER): study protocol for a multicentre study. BMJ Open 10 (4) : e036598-e036598. ScholarBank@NUS Repository.
Abstract: BackgroundPatients at their end-of-life (EOL) phase frequently visit the emergency department (ED) due to their symptoms, yet the environment and physicians in ED are not traditionally equipped or trained to provide palliative care. This multicentre study aims to measure the current quality of EOL care in ED to identify gaps, formulate improvements and implement the improved EOL care protocol. We shall also evaluate healthcare resource utilisation and its associated costs.Methods and analysisThis study employs a quasiexperimental interrupted time series design using both qualitative and quantitative methods, involving the EDs of three tertiary hospitals in Singapore, over a period of 3 years. There are five phases in this study: (1) retrospective chart reviews of patients who died within 5 days of ED attendance; (2) pilot phase to validate the CODE questionnaire in the local context; (3) preimplementation phase; (4) focus group discussions (FGDs); and (5) postimplementation phase. In the prospective cohort, patients who are actively dying or have high likelihood of mortality this admission, and whose goal of care is palliation, will be eligible for inclusion. At least 140 patients will be recruited for each preimplementation and postimplementation phase. There will be face-to-face interviews with patients’ family members, review of medical records and self-administered staff survey to evaluate existing knowledge and confidence. The FGDs will involve hospital and community healthcare providers. Data obtained from the retrospective cohort, preimplementation phase and FGDs will be used to guide prospective improvement and protocol changes. Patient, family and staff relevant outcomes from these changes will be measured using time series regression.Ethics and disseminationThe study protocol has been reviewed and ethics approval obtained from the National Healthcare Group Domain Specific Review Board, Singapore. The results from this study will be actively disseminated through manuscript publications and conference presentations.Trial registration numberNCT03906747.
Source Title: BMJ Open
ISSN: 20446055
DOI: 10.1136/bmjopen-2019-036598
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