73 Dying matters in the emergency department; understanding the end-of-life care delivered to patients in a major trauma centre

<h3>Background</h3> End of life care (EOLC) is a national priority from the National Health Service in the United Kingdom (UK). One of the few guarantees in life is that we all die. There is limited data or evidence around what EOLC involves in the ED and the patient’s experience of this. We are a major trauma centre in the UK seeing around 250000 people annually. This work was looking to understand the EOLC delivered for our patients. <h3>Method</h3> A retrospective review of patients aged 18 years and over who died in our ED was conducted. Data collected included demographics, frailty scores, time of arrival, time of death, time of EOL decision, cause of death in the ED, who wrote do not resuscitate (DNACPR) forms, whether local guidance was being followed for EOL care and who was involved in those EOL discussions. Data from relatives of those who died in the department was also collected. <h3>Results</h3> From January – December 2023 328 patients died in the ED. 76% of patients were aged, 65 years or over, with 69% having a clinical frailty score of 5 or more. The average time from arrival to death was 5 hours 45 minutes, with the average time from EOL decision to death being 1 hour and 42 minutes. 60% of all patients had a DNACPR, with 75% of those being written by ED clinicians. With this being more prominent in those as the clinical frailty score got higher. The most common reason for death was cardiac arrest, myocardial infarction and sepsis. <h3>Conclusion</h3> Our ED looks after many dying patients in their final hours. It is clear this is a challenging environment for many reasons. EOLC is becoming ever important in the ED. Further work is needed to see if our local experience matches other EDs.