Palliative Care in the Emergency Department (ED)
Introduction
Emergency departments increasingly encounter patients who are at, or very near, the end of life. While resuscitation and stabilisation are core ED functions, clinicians must also recognise when the goals of care should shift from life‑prolongation to comfort, dignity and symptom relief.
This section condenses ED‑focused, exam‑relevant guidance on recognising dying patients, immediate priorities, common symptom management, communication and documentation, pathways for transfer, and quality measures (NICE NG31; RCEM toolkit).
The role of the ED in palliative care The ED’s essential functions when caring for people approaching the end of life are:
- Rapid identification of dying or irreversible terminal trajectories.
- Immediate relief of distressing symptoms (pain, breathlessness, agitation, nausea, secretions).
- Early clarification and documentation of goals of care (capacity assessment, DNACPR/ReSPECT, advance directives).
- Avoidance of futile or burdensome interventions that do not improve comfort.
- Facilitation of transfer to a more appropriate setting (hospice, home with community support) and rapid referral to specialist palliative services.
- Communication and support for family and carers, including signposting to bereavement resources (GOV.UK “One Chance to Get It Right”; RCEM).
Recognising the dying patient
Timely recognition allows appropriate planning, anticipatory prescribing and compassionate communication. Consider that a patient may be dying when several of the following are present: