Palliative care service at emergency dept in NUH

National University Hospital's Associate Consultant for Emergency Medicine Rakhee Yash Pal counseling Madam Mumina d/o Jahabar. NUH is the first hospital to roll out a palliative care service, as part of care and service, at its Emergency Medicine Department.
PHOTO: Palliative care service at emergency dept in NUH

SINGAPORE - The National University Hospital has started a dedicated palliative care service in its emergency medicine department (EMD) to help relieve the suffering of patients.

Doctors have seen the need for such a service as the department has seen a rise in the number of deaths of elderly patients, many of whom suffer from advanced chronic or terminal illnesses.

In 2011, about 50 per cent of the 400 patients who died in NUH's EMD were 65 years or older. This rose to 55 per cent, of the 414 patients who died there last year.

"As our population ages, patients with advanced chronic illness with crisis events, such as severe pneumonia or heart attack, are likely to increase," said NUH associate consultant for emergency medicine Rakhee Yash Pal.

"The default mode in emergency medicine is maximum resuscitation, but not every patient might want that or benefit from that," she said.

Patients and their family members might have to wait several hours to see a palliative specialist, especially for an emergency at night.

"Some might not even make it. That's why we have to train EMD staff to handle these situations," said Dr Yash Pal.

For a start, the department has carved out a quiet room, where patients can spend their last moments with family members in a comfortable environment, instead of being surrounded by beeping machines and busy hospital staff in a public area.

The room also allows more family members - about 10 - to enter at any one time. Before, only two at a time were usually allowed.

NUH is starting with one quiet room in its EMD but could expand this to three next year. Doctors and nurses in the department will also be trained to prepare family members for the death of their loved ones.

"It's all about asking the right questions. Instead of asking 'Do you want to go all the way?', the question might be 'Did your loved one say anything about having tubes and lines in him in his last moments?'," said Dr Yash Pal.

They will also be trained to advise family members on how to care for their dying loved ones if the patients wish to die at home. This is important as a Lien Foundation survey found that 77 per cent preferred to die at home.

The new palliative service rolled out last month has already benefited some.

Chef Mumina Jahabar's cousin, Mr Shamsuddin Shaul Hameed, spent some of his last moments in the EMD's quiet room. In the room with light-coloured walls and soothing garden motifs, Mr Shamsuddin said his last prayers.

"There was privacy - he felt very treasured in these last moments," said Ms Jahabar, 46.

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