By Dr Puneet Seth
Department of Emergency Medicine, SGH

Palliative care in the Emergency Department (ED) is a long overdue area of focus. Everyone deserves dignity and comfort in their final moments, and when these moments happen in the ED, we can make a big difference to how patients breathe their last.
Given the fast pace of the ED environment, paying close attention to small details of a patient’s last moments is especially impactful if we do our part to make sure that no one dies feeling breathless, in immense pain, in soiled clothing or alone, surrounded only by machines.
If we can, we should also try to ensure that the dying patient can spend his last moments with his loved ones, in dignity. Very often, this requires making the necessary changes to ED processes to make this a reality.
At the SGH ED, the moment a patient comes in, we identify the appropriate extent of care based on discussions between the patient, family and attending medical team. If prolonging life is not possible, we initiate the Comfort Care Pathway. Just in the last six months, we saw about 30 such cases.
This pathway, created with Dr Grace Yang, Associate Consultant at NCCS Palliative Medicine, ensures that the patient is immediately relieved of pain as much as possible, is clean, comfortable and can spend the last moments with family members in private.
"The worst thing we can do is to be indifferent to them, and believe that nothing else can be done, just because we cannot provide a cure."
The success of this pathway is thanks to a multiprofessional effort, including bed managers, medical social workers and palliative care specialists working together quickly. Still, there are challenges we need to overcome.
In the ED, it is easy to be distracted by many things happening simultaneously. We need to be constantly mindful of the needs of this group of patients.
The worst thing we can do is to be indifferent to them, and believe that nothing else can be done, just because we cannot provide a cure. Our ED staff also need to slow down, lest they come across as uncaring and create the wrong impression of having given up on the patient.
Another challenge lies in striking the fine balance between providing too little or too much care. While we acknowledge the inevitable end is near for this group of patients, the difficulty lies in the unpredictability of the event.
Resources are always finite and we need to do our best in ensuring that the appropriate level of care is given to all patients. This is especially critical during peak hours, where skilled manpower and physical spaces are limited.
Nevertheless, we continue to try our best. As the saying aptly sums it up, “Although treatment can be futile, care never is.”