1
|
Harhara T, Buhumaid R, Oyoun Alsoud L, Ibrahim H. Palliative care education: a nationwide qualitative study of emergency medicine residency program directors in the United Arab Emirates. Int J Emerg Med 2024; 17:69. [PMID: 38783214 PMCID: PMC11119274 DOI: 10.1186/s12245-024-00643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Emergency medicine (EM) physicians routinely care for patients with serious life-limiting illnesses. Educating EM residents to have general skills and competencies in palliative medicine is a global priority. The purpose of this study was to describe the current status of palliative and end-of-life education in EM residency programs in the United Arab Emirates (UAE) and to identify barriers and opportunities to inculcating palliative care (PC) instruction into EM training in a non-Western setting. METHODS Using the American College of Emergency Medicine's milestones for Hospice and Palliative Medicine for Emergency Medicine as a question guide, semi-structured interviews were conducted with program directors of all 7 EM residency programs in the UAE from January through July 2023. Qualitative content analysis was conducted to identify recurring themes. RESULTS All program directors agreed that PC knowledge and skills are essential components of training for EM residents but have had variable success in implementing a structured PC curriculum. Six themes emerged, namely the educational curriculum, PC policies and practices, comprehensive PC services, cultural and religious barriers to PC, EM scope of practice, and supporting residents after patient death. CONCLUSION UAE national EM residency curriculum development is evolving with an emphasis on developing a structured PC curriculum. As EM residencies implement policies and programs to improve care for patients and families dealing with serious illness, future studies are needed to assess the impact of these initiatives on patient quality of life and physician well-being.
Collapse
Affiliation(s)
- Thana Harhara
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Rasha Buhumaid
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Department of Emergency Medicine, Rashid Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Leen Oyoun Alsoud
- Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Halah Ibrahim
- Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates.
| |
Collapse
|
2
|
Karim R, Saheed M, Kies J, Churchill M, Vemula B, Doberman DJ. Feasibility of a Two-Step Palliative Screening Utilizing Existing Emergency Department Resources. J Pain Symptom Manage 2024; 67:e417-e424. [PMID: 38369250 DOI: 10.1016/j.jpainsymman.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Although the Emergency Department (ED) offers a unique setting to provide early palliative care, staffing limitations curtail hospitals from establishing ED-palliative partnerships. MEASURES Feasibility of a two-step ED-palliative screening protocol was defined by two criteria: a ≥ 50% increase in palliative consults originating from the ED and a ≥ 50% consultation completion rate for patients who screened positive for unmet palliative needs. INTERVENTION A clinical decision support tool identified patients with treatment/code status limitations and prompted a care coordination referral. Care coordinators screened patients for unmet palliative needs using a content-validated screening tool and consulted palliative care for positive screens. OUTCOME Palliative care consultations originating from the ED increased by 110% from 32 to 67 consultations, and 57% (40/70) of patients who screened positive for unmet palliative needs received a consultation. CONCLUSIONS/LESSONS LEARNED Our project demonstrated feasibility of a two-step ED-palliative protocol by increasing palliative care consultation without necessitating additional staff.
Collapse
Affiliation(s)
- Razeen Karim
- Department of Medicine (R.K., J.K., M.C., B.V., D.D.), Section of Palliative Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Mustapha Saheed
- Department of Emergency Medicine (M.S., B.V.), The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jamison Kies
- Department of Medicine (R.K., J.K., M.C., B.V., D.D.), Section of Palliative Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle Churchill
- Department of Medicine (R.K., J.K., M.C., B.V., D.D.), Section of Palliative Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Balakrishna Vemula
- Department of Medicine (R.K., J.K., M.C., B.V., D.D.), Section of Palliative Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Emergency Medicine (M.S., B.V.), The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Danielle J Doberman
- Department of Medicine (R.K., J.K., M.C., B.V., D.D.), Section of Palliative Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Kennedy M, Rico JS, Liu SW, Engel KG, Ritchie CS. Emergency Palliative Care: Early Assessment of an Older Adult With a Fall and Hip Fracture. J Palliat Med 2024; 27:430-433. [PMID: 37862570 DOI: 10.1089/jpm.2023.0258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
In this segment of the emergency department (ED) palliative care case series, we present a patient who arrives to the ED after a fall resulting in a hip fracture. He is also found to have hypernatremia and an acute kidney injury and develops delirium while in the ED awaiting an inpatient bed. The ED-based integrated geriatric palliative care program is consulted and performs a multidimensional assessment. The geriatric palliative care clinician facilitates discussion with his daughter about surgical intervention based on the patient's goals and values, diagnoses delirium, and worsening depression, creates a plan for delirium and pain management, and accelerates postdischarge planning.
Collapse
Affiliation(s)
- Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Emergency, Harvard Medical School, Boston, Massachusetts, USA
| | - Janet S Rico
- Division Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Emergency, Harvard Medical School, Boston, Massachusetts, USA
| | - Kirsten G Engel
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christine S Ritchie
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Johnston BM, Miller M, Normand C, Cardona M, May P, Lowney AC. Primary data on symptom burden and quality of life among elderly patients at risk of dying during unplanned admissions to an NHS hospital: a cohort study using EuroQoL and the integrated palliative care outcome scale. BMC Palliat Care 2024; 23:46. [PMID: 38374101 PMCID: PMC10877897 DOI: 10.1186/s12904-024-01384-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/15/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Older people account heavily for palliative care needs at the population level and are growing in number as the population ages. There is relatively little high-quality data on symptom burden and quality of life, since these data are not routinely collected, and this group are under-recruited in primary research. It is unclear which measurement tools are best suited to capture burdens and experience. METHODS We recruited a cohort of 221 patients aged 75 + years with poor prognosis who had an unplanned admission via the emergency department in a large urban hospital in England between 2019 and 2020. Risk of dying was assessed using the CriSTAL tool. We collected primary data and combined these with routine health records. Baseline clinical data and patient reported quality of life outcomes were collected on admission and reassessed within the first 72 h of presentation using two established tools: EQ-5D-5 L, EQ-VAS and the Integrated Palliative Outcomes Scale (IPOS). RESULTS Completion rate was 68% (n = 151) and 33.1% were known to have died during admission or within 6 months post-discharge. The vast majority (84.8%) reported severe difficulties with at least one dimension of EQ-5D-5 L at baseline and improvements in EQ-VAS observed at reassessment in 51.7%. The baseline IPOS revealed 78.2% of patients rating seven or more items as moderate, severe or overwhelming, but a significant reduction (-3.6, p < 0.001) in overall physical symptom severity and prevalence was also apparent. No significant differences were noted in emotional symptoms or changes in communication/practical issues. IPOS total score at follow up was positively associated with age, having comorbidities (Charlson index score > = 1) and negatively associated with baseline IPOS and CriSTAL scores. CONCLUSION Older people with poor prognosis admitted to hospital have very high symptom burden compared to population norms, though some improvement following assessment was observed on all measures. These data provide valuable descriptive information on quality of life among a priority population in practice and policy and can be used in future research to identify suitable interventions and model their effects.
Collapse
Affiliation(s)
- Bridget M Johnston
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland.
| | - Mary Miller
- Department of Palliative Care, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Nuffield Department of Medicine, Oxford University, Oxford, England
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, England
| | - Magnolia Cardona
- Faculty of Health and Behavioural Sciences, School of Psychology, The University of Queensland, Brisbane, Australia
- Institute for Evidence Based Healthcare, Bond University, Gold Coast, Australia
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, England
| | - Aoife C Lowney
- Department of Palliative Care, Marymount University Hospital and Hospice and Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
| |
Collapse
|
5
|
Prachanukool T, George N, Bowman J, Ito K, Ouchi K. Best Practices in End of Life and Palliative Care in the Emergency Department. Clin Geriatr Med 2023; 39:575-597. [PMID: 37798066 DOI: 10.1016/j.cger.2023.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Three-quarters of patients over the age of 65 visit the emergency department (ED) in the last six months of their lives. Approximately 20% of hospice residents have ED visits. These patients must decide whether to receive emergency care that prioritizes life support, which may not achieve their desired outcomes and might even be futile. The patients in these end-of-life stages could benefit from early palliative care or hospice consultation before they present to the ED. Furthermore, early integration of palliative care at the time of ED visits is important in establishing the goals of the entire treatment.
Collapse
Affiliation(s)
- Thidathit Prachanukool
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand; Department of Emergency Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA 02115, USA.
| | - Naomi George
- Division of Critical Care Medicine, Department of Emergency Medicine, University of New Mexico School of Medicine, 700 Camino de Salud, Albuquerque, NM 87131, USA
| | - Jason Bowman
- Department of Emergency Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA 02115, USA; Department of Psychosocial Oncology and Palliative Medicine, Dana Farber Cancer Institute, 75 Francis Street, Neville House, Boston, MA 02115, USA
| | - Kaori Ito
- Department of Emergency Medicine, Division of Acute Care Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8606, Japan
| | - Kei Ouchi
- Department of Emergency Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA 02115, USA; Department of Psychosocial Oncology and Palliative Medicine, Dana Farber Cancer Institute, 75 Francis Street, Neville House, Boston, MA 02115, USA
| |
Collapse
|
6
|
Neugarten C, Baldeo R, Tian K, Piscitello G, O'Mahony S, Kaginele P, Wang DH. The value of embedded palliative care in the emergency department. Acad Emerg Med 2023; 30:870-873. [PMID: 36757676 DOI: 10.1111/acem.14684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Affiliation(s)
- Carter Neugarten
- Section of Palliative Care, Departments of Internal Medicine and Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan Baldeo
- Division of Palliative Medicine, Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Katherine Tian
- Department of Internal Medicine, The South Bend Clinic, South Bend, Indiana, USA
| | - Gina Piscitello
- Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sean O'Mahony
- Section of Palliative Care, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Pranita Kaginele
- Department of Emergency Medicine, St. Barnabas Hospital, Bronx, New York, USA
| | - David H Wang
- Department of Palliative Medicine, Scripps Health, San Diego, California, USA
| |
Collapse
|
7
|
Wilson PM, Ramar P, Philpot LM, Soleimani J, Ebbert JO, Storlie CB, Morgan AA, Schaeferle GM, Asai SW, Herasevich V, Pickering BW, Tiong IC, Olson EA, Karow JC, Pinevich Y, Strand J. Effect of an Artificial Intelligence Decision Support Tool on Palliative Care Referral in Hospitalized Patients: A Randomized Clinical Trial. J Pain Symptom Manage 2023; 66:24-32. [PMID: 36842541 DOI: 10.1016/j.jpainsymman.2023.02.317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/26/2023]
Abstract
CONTEXT Palliative care services are commonly provided to hospitalized patients, but accurately predicting who needs them remains a challenge. OBJECTIVES To assess the effectiveness on clinical outcomes of an artificial intelligence (AI)/machine learning (ML) decision support tool for predicting patient need for palliative care services in the hospital. METHODS The study design was a pragmatic, cluster-randomized, stepped-wedge clinical trial in 12 nursing units at two hospitals over a 15-month period between August 19, 2019, and November 17, 2020. Eligible patients were randomly assigned to either a medical service consultation recommendation triggered by an AI/ML tool predicting the need for palliative care services or usual care. The primary outcome was palliative care consultation note. Secondary outcomes included: hospital readmissions, length of stay, transfer to intensive care and palliative care consultation note by unit. RESULTS A total of 3183 patient hospitalizations were enrolled. Of eligible patients, A total of 2544 patients were randomized to the decision support tool (1212; 48%) and usual care (1332; 52%). Of these, 1717 patients (67%) were retained for analyses. Patients randomized to the intervention had a statistically significant higher incidence rate of palliative care consultation compared to the control group (IRR, 1.44 [95% CI, 1.11-1.92]). Exploratory evidence suggested that the decision support tool group reduced 60-day and 90-day hospital readmissions (OR, 0.75 [95% CI, 0.57, 0.97]) and (OR, 0.72 [95% CI, 0.55-0.93]) respectively. CONCLUSION A decision support tool integrated into palliative care practice and leveraging AI/ML demonstrated an increased palliative care consultation rate among hospitalized patients and reductions in hospitalizations.
Collapse
Affiliation(s)
- Patrick M Wilson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.M.W, J.O.E., C.B.S., G.M.S.), Rochester, Minnesota, USA.
| | - Priya Ramar
- Department of Medicine (P.R., L.M.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Lindsey M Philpot
- Department of Medicine (P.R., L.M.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Jalal Soleimani
- Department of Anesthesiology (J.S., V.H., B.W.P., Y.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Jon O Ebbert
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.M.W, J.O.E., C.B.S., G.M.S.), Rochester, Minnesota, USA; Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| | - Curtis B Storlie
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.M.W, J.O.E., C.B.S., G.M.S.), Rochester, Minnesota, USA; Department of Health Sciences Research (C.B.S.), Mayo Clinic, Rochester, Minnesota, USA
| | - Alisha A Morgan
- Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| | - Gavin M Schaeferle
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.M.W, J.O.E., C.B.S., G.M.S.), Rochester, Minnesota, USA
| | - Shusaku W Asai
- Health Analytics | Global Health and Wellbeing (S.W.A.), Delta Air Lines, Atlanta, Georgia, USA
| | - Vitaly Herasevich
- Department of Anesthesiology (J.S., V.H., B.W.P., Y.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Brian W Pickering
- Department of Anesthesiology (J.S., V.H., B.W.P., Y.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Ing C Tiong
- Department of Information Technology (I.C.T.), Mayo Clinic, Rochester, Minnesota, USA
| | - Emily A Olson
- Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| | - Jordan C Karow
- Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| | - Yuliya Pinevich
- Department of Anesthesiology (J.S., V.H., B.W.P., Y.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Jacob Strand
- Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
8
|
Ginsburg AD, Arnold RM, Silverman EJ. Increasing Our Footprint: Palliative Care in the Emergency Department. J Palliat Med 2023; 26:604-605. [PMID: 37130282 DOI: 10.1089/jpm.2023.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Affiliation(s)
- Alexander D Ginsburg
- Section of Palliative Care, Division of Community Internal Medicine, Geriatrics, and Palliative Care, Departments of Emergency Medicine, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Robert M Arnold
- Palliative Research Center, Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ethan J Silverman
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
9
|
Iguina MM, Danyalian AM, Luque I, Shaikh U, Kashan SB, Morgan D, Heller D, Danckers M. Characteristics, ICU Interventions, and Clinical Outcomes of Patients With Palliative Care Triggers in a Mixed Community-Based Intensive Care Unit. J Palliat Care 2023; 38:126-134. [PMID: 36632687 DOI: 10.1177/08258597221145326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Integration of palliative care initiatives in the intensive care unit (ICU) benefit patients and improve outcomes. Palliative care triggers (PCTs) is a screening tool that aides in stratifying patients who would benefit most from an early palliative care approach. There is no consensus on PCT selection or best timing for implementation. We evaluated the clinical characteristics, ICU and palliative care interventions, and clinical outcomes of critically ill patients with PCT in a community-based mixed ICU. Methods: This retrospective study was conducted in a 44-bed adult, mixed ICU in a 407-bed community-based teaching hospital in Florida. Eleven PCTs were used as a screening tool during multidisciplinary rounds (MDRs). Patients were analyzed based on presence or absence of PCT as well as having met high (>2) versus low (<2) PCT. Data collected included patient demographics, ICU resource utilization and clinical outcomes. We considered a two-sided P value of less than .05 to indicate statistical significance with a 95% confidence interval. Results: Of 388 ICU patients, 189 (48.7%) met at least 1 PCT and 199 (51.3%) did not. The trigger group had higher Acute Physiology and Chronic Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA) scores within 24 h of ICU admission. The most common PCTs identified were ICU length of stay greater than 7 days or readmission to ICU, terminal prognosis and assisting family in transitioning goals of care. There were statistically significant differences in ICU resource utilization, palliative care interventions, and overall worse clinical outcomes in the trigger-detected group. Similar findings were seen in the cohort with high PCT (>2). Conclusions: Our study supports the implementation of a tailored 11-item palliative care screening tool to effectively identify ICU patients with high ICU and palliative care interventions and worse clinical outcomes.
Collapse
Affiliation(s)
- Michele M Iguina
- Department of Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
- Division of Critical Care, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Aunie M Danyalian
- Department of Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
- Division of Critical Care, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Ilko Luque
- Research Department, Graduate Medical Education, HCA East Florida Division, 23686Aventura Hospital and Medical Center, Aventura, FL, USA
| | - Umair Shaikh
- Department of Medicine, Piedmont Eastside Medical Center, Snellville, GA, USA
| | - Sanaz B Kashan
- Department of Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Dionne Morgan
- Department of Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
- Division of Critical Care, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Daniel Heller
- Department of Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
- Division of Critical Care, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Mauricio Danckers
- Department of Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
- Division of Critical Care, HCA Florida Aventura Hospital, Aventura, FL, USA
| |
Collapse
|
10
|
Stoltenberg MJ, Kennedy M, Rico J, Russell M, Petrillo LA, Engel KG, Kamdar M, Ouchi K, Wang DH, Bernacki RH, Biese K, Aaronson E. Developing a novel integrated geriatric palliative care consultation program for the emergency department. J Am Coll Emerg Physicians Open 2022; 3:e12860. [PMCID: PMC9742608 DOI: 10.1002/emp2.12860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022] Open
Abstract
With the aging of our population, older adults are living longer with multiple chronic conditions, frailty, and life‐limiting illnesses, which creates specific challenges for emergency departments (EDs). Older adults and those with serious illnesses have high rates of ED use and hospitalization, and the emergency care they receive may be discordant with their goals and values. In response, new models of care delivery have begun to emerge to address both geriatric and palliative care needs in the ED. However, these programs are typically siloed from one another despite significant overlap. To develop a new combined model, we assembled stakeholders and thought leaders at the intersection of emergency medicine, palliative care, and geriatrics and used a consensus process to define elements of an ideal model of a combined palliative care and geriatric intervention in the ED. This article provides a brief history of geriatric and palliative care integration in EDs and presents the integrated geriatric and palliative care model developed.
Collapse
Affiliation(s)
- Mark J. Stoltenberg
- Division of Palliative Care and Geriatric MedicineMassachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Maura Kennedy
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Janet Rico
- Division of Palliative Care and Geriatric MedicineMassachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Matthew Russell
- Division of Palliative Care and Geriatric MedicineMassachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Laura A. Petrillo
- Division of Palliative Care and Geriatric MedicineMassachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Kirsten G. Engel
- Division of Palliative Care and Geriatric MedicineMassachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Mihir Kamdar
- Division of Palliative Care and Geriatric MedicineMassachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Kei Ouchi
- Harvard Medical SchoolBostonMassachusettsUSA,Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA,Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - David H. Wang
- Division of Palliative MedicineScripps HealthSan DiegoCaliforniaUSA
| | - Rachelle H. Bernacki
- Harvard Medical SchoolBostonMassachusettsUSA,Ariadne LabsBrigham and Women's Hospital & Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA,Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Kevin Biese
- West Health InstituteLa JollaCaliforniaUSA,Department of Emergency MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Emily Aaronson
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| |
Collapse
|
11
|
Voaklander B, Gaudet LA, Kirkland SW, Keto-Lambert D, Villa-Roel C, Rowe BH. Interventions to improve consultations in the emergency department: A systematic review. Acad Emerg Med 2022; 29:1475-1495. [PMID: 35546740 DOI: 10.1111/acem.14520] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/21/2022] [Accepted: 05/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Emergency department (ED) consultations with specialists are necessary for safe and effective patient care. Delays in the ED consultation process, however, have been shown to increase ED length of stay (LOS) and contribute to ED crowding. This review aims to describe and evaluate the effectiveness of interventions to improve the ED consultation process. METHODS Eight primary literature databases and the gray literature were searched to identify comparative studies assessing ED-based interventions to improve the specialist consultation process. Two independent reviewers identified eligible studies, assessed study quality, and extracted data. Individual or pooled meta-analysis for continuous outcomes were calculated as mean differences (MDs) with 95% confidence intervals (CIs) using a random-effects model was conducted. RESULTS Thirty-five unique comparative intervention studies were included. While the interventions varied, four common components/themes were identified including interventions to improve consultant responsiveness (n = 11), improve access to consultants in the ED (n = 9), expedite ED consultations (n = 8), and bypass ED consultations (n = 7). Studies on interventions to improve consult responsiveness consistently reported a decrease in consult response times in the intervention group with percent changes between 10% and 71%. Studies implementing interventions to improve consult responsiveness (MD -2.55, 95% CI -4.88 to -0.22) and interventions to bypass ED consultations (MD -0.99, 95% CI -1.43 to -0.56) consistently reported a decrease in ED LOS; however, heterogeneity was high (I2 = 99%). Evidence on whether any of the interventions were effective at reducing the proportion of patients consulted or subsequently admitted varied. CONCLUSIONS The various interventions impacting the consultation process were predominately successful in reducing ED LOS, with evidence suggesting that interventions improving consult responsiveness and improving access to consultants in the ED also improve consult response times. Health care providers looking to implement interventions to improve the ED consultation process should identify key areas in their setting that could be targeted.
Collapse
Affiliation(s)
- Britt Voaklander
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lindsay A Gaudet
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
| | - Scott W Kirkland
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Diana Keto-Lambert
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cristina Villa-Roel
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
12
|
Benesch TD, Moore JE, Breyre AM, DeWitt R, Nattinger CC, Dellinger E, Anderson ES, Bulman L. Primary palliative care education in emergency medicine residency: A mixed-methods analysis of a yearlong, multimodal intervention. AEM EDUCATION AND TRAINING 2022; 6:e10823. [PMID: 36562021 PMCID: PMC9763971 DOI: 10.1002/aet2.10823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 05/31/2023]
Abstract
Background Emergency medicine (EM) physicians frequently care for seriously ill patients at the end of life. Palliative care initiated in the emergency department (ED) can improve symptom management and quality of life, align treatments with patient preferences, and reduce length of hospitalization. We evaluated an educational intervention with digital tools for palliative care discussions in an urban EM residency using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. Methods Our intervention, conducted from July 2020 to August 2021, included education on palliative care techniques, digital tools, and incentives for participation. We tracked goals of care conversations and palliative care consults using electronic medical record data, conducted pre- and posttraining surveys, and used semistructured interviews to assess resident perspectives on palliative care conversations in the ED. Outcomes included number of goals of care conversations recorded by EM residents, consults to palliative care from the ED, and resident perspectives on palliative care in EM. Results The results were as follows: reach-45 residents participated in the intervention; effectiveness-89 goals of care conversations were documented by 23 ED residents, and palliative care consults increased from approximately four to 10 monthly; adoption-over half the residents who participated in the intervention documented goals of care discussions using an electronic dotphrase; implementation-by the completion of the intervention, residents reported increased comfort with goals of care conversations, saw palliative care as part of their responsibility as EM physicians, and effectively documented goals of care discussions; and maintenance-at 2-month follow up, palliative care consults from the ED remained at approximately 10 monthly, and digital tools to prompt and track palliative care discussions remained in use. Conclusions An integrated palliative care training for EM residents with technological assists was successful in facilitating goals of care discussions and increasing palliative care consults from the ED.
Collapse
Affiliation(s)
| | | | - Amelia M. Breyre
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Raizel DeWitt
- Joint Medical ProgramUniversity of California, Berkeley and University of California, San FranciscoCaliforniaBerkeleyUSA
| | - Caroline C. Nattinger
- Joint Medical ProgramUniversity of California, Berkeley and University of California, San FranciscoCaliforniaBerkeleyUSA
| | | | | | - Linda Bulman
- Alameda Health SystemHighland HospitalOaklandCaliforniaUSA
| |
Collapse
|
13
|
Bowman JK, Aaronson EL, Petrillo LA, Jacobsen JC. Goals of Care Conversations Documented by an Embedded Emergency Department-Palliative Care Team during COVID. J Palliat Med 2022; 26:662-666. [PMID: 36378862 DOI: 10.1089/jpm.2022.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: There has been growing interest around integrating palliative care (PC) into emergency department (ED) practice but concern about feasibility and impact. In 2020, as the COVID pandemic was escalating, our hospital's ED and PC leadership created a new service of PC clinicians embedded in the ED. Objectives: To describe the clinical work of the embedded ED-PC team, in particular what was discussed during goals of care conversations. Design: Prospective patient identification followed by retrospective electronic health record chart extraction and analysis. Settings/Subjects: Adult ED patients in an academic medical center in the United States. Measurements/Results: The embedded ED-PC team saw 159 patients, whose mean age was 77.5. Nearly all patients were admitted, 48.0% had confirmed or presumed COVID, and overall mortality was 29.1%. Of the patients seen, 58.5% had a serious illness conversation documented as part of the consult. The most common topics addressed were patient (or family) illness understanding (96%), what was most important (92%), and a clinical recommendation (91%). Clinicians provided a prognostic estimate in 57/93 (61.3%) of documented discussions. In the majority of cases where prognosis was discussed, it was described as poor. Conclusion: Specialist PC clinicians embedded in the ED can engage in high-quality goals of care conversations that have the potential to align patients' hospital trajectory with their preferences.
Collapse
Affiliation(s)
- Jason K. Bowman
- Department of Emergency Medicine and Brigham & Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Brigham & Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily L. Aaronson
- Department of Emergency Medicine and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura A. Petrillo
- Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliet C. Jacobsen
- Department of Palliative Care and Geriatric Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Lund University Institute for Palliative Care, Lund, Sweden
| |
Collapse
|
14
|
Wang DH, Heidt R. Emergency Department Embedded Palliative Care Service Creates Value for Health Systems. J Palliat Med 2022; 26:646-652. [PMID: 36367980 DOI: 10.1089/jpm.2022.0245] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Emergency department (ED)-initiated palliative care consultation facilitates goal-concordant care while stewarding resource utilization. Delivery models are being piloted without clear operational and financial sustainability. Objective: To demonstrate that embedding a palliative care consultation service in the ED is clinically meaningful, operationally viable, and yields significant return on investment (ROI). Methods: Quasi-experimental study from August 17, 2020 to August 17, 2021. We established an ED-embedded palliative care consultation service at a 350-bed urban community hospital with 45,000 annual ED visits. A singe palliative care provider stationed in the main ED workstation area from 11 am to 7 pm daily. Matched analysis compared ED-embedded consultations against Floor and intensive care unit (ICU) consultations originating from usual practice. Results: ED consultations increased 10x, without cannibalization, to become the hospital's primary source of palliative care consultations. Clinical outcomes were meaningful, with 49% changing code status, 11% admitting to lower level of care, 11% avoiding hospitalization, 17% newly referred to hospice, and 21% newly referred to palliative care clinic. ED length of stay (LOS) did not lengthen, and ED staff strongly agreed that the service was valuable and unobtrusive. Compared with Floor, ED consultations had 8.1 days shorter hospital LOS (3.0 vs. 11.1 days, p < 0.01) with $5,974 lower median direct costs for index hospitalization ($6,211 vs. $12,005, p < 0.01). Compared with ICU, ED consultations had 4.2 days shorter hospital LOS (3.0 vs. 7.2 days, p < 0.01) with $9,332 lower median direct costs for index hospitalization ($14,093 vs. $23,425, p < 0.01). ROI was 6.7x net of foregone revenue and labor expenses. Conclusions and Relevance: This ED-embedded palliative care consultation service was clinically meaningful, operationally viable, and delivered a 6.7x ROI. ED-palliative partnerships present a quadruple aim opportunity to improve care for seriously ill patients.
Collapse
Affiliation(s)
- David H Wang
- Department of Palliative Medicine, Scripps Health, San Diego, California, USA
| | - Ryan Heidt
- Department of Palliative Medicine, Scripps Health, San Diego, California, USA
| |
Collapse
|
15
|
Aaronson EL, Wright RJ, Ritchie CS, Grudzen CR, Ankuda CK, Bowman JK, Kuntz JG, Ouchi K, George N, Jubanyik K, Bright LE, Bickel K, Isaacs E, Petrillo LA, Carpenter C, Goett R, LaPointe L, Owens D, Manfredi R, Quest T. Mapping the future for research in emergency medicine palliative care: A research roadmap. Acad Emerg Med 2022; 29:963-973. [PMID: 35368129 DOI: 10.1111/acem.14496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The intersection of emergency medicine (EM) and palliative care (PC) has been recognized as an essential area of focus, with evidence suggesting that increased integration improves outcomes. This has resulted in increased research in EM PC. No current framework exists to help guide investigation and innovation. OBJECTIVE The objective was to convene a working group to develop a roadmap that would help provide focus and prioritization for future research. METHODS Participants were identified based on clinical, operation, policy, and research expertise in both EM and PC and spanned physician, nursing, social work, and patient perspectives. The research roadmap setting process consisted of three distinct phases that were time staggered over 12 months and facilitated through three live video convenings, asynchronous input via an online document, and a series of smaller video convenings of work groups focused on specific topics. RESULTS Gaps in the literature were identified and informed the four key areas for future research. Consensus was reached on these domains and the associated research questions in each domain to help guide future study. The key domains included work focused on the value imperative for PC in the emergency setting, models of care delivery, disparities, and measurement of impact and efficacy. Additionally, the group identified key methodological considerations for doing work at the intersection of EM and PC. CONCLUSIONS There are several key domains and associated questions that can help guide future research in ED PC. Focus on these areas, and answering these questions, offers the potential to improve the emergency care of patients with PC needs.
Collapse
Affiliation(s)
- Emily L. Aaronson
- Department of Emergency Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | | | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Mongan Institute Center for Aging and Serious Illness Boston Massachusetts USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine NYU Grossman School of Medicine, NYU Langone Health/Bellevue Hospital Center New York New York USA
| | - Claire K. Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Jason K. Bowman
- Department of Emergency Medicine Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USA
- Department of Psychosocial Oncology and Palliative Care Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Joanne G. Kuntz
- Department of Palliative and Supportive Care Emory University Hospital Midtown, Emory University School of Medicine Atlanta Georgia USA
| | - Kei Ouchi
- Department of Emergency Medicine Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USA
- Department of Psychosocial Oncology and Palliative Care Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Naomi George
- Department of Emergency Medicine and Division of Adult Critical Care University of New Mexico School of Medicine Albuquerque New Mexico USA
| | - Karen Jubanyik
- Emergency Department Yale University School of Medicine New Haven Connecticut USA
| | - Leah E. Bright
- Department of Emergency Medicine Johns Hopkins Hospital Baltimore Maryland USA
| | - Kathleen Bickel
- Hospice and Palliative Medicine in the Division of General Internal Medicine University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Eric Isaacs
- Emergency Department Zuckerberg San Francisco General Hospital, University of California at San Francisco San Francisco California USA
| | - Laura A. Petrillo
- Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Christopher Carpenter
- Washington University School of Medicine in St. Louis St. Louis Missouri USA
- Department of Emergency Medicine Rutgers New Jersey Medical School Newark New Jersey USA
| | - Rebecca Goett
- Department of Emergency Medicine Rutgers New Jersey Medical School Newark New Jersey USA
| | - Lauren LaPointe
- Department of Social Work Massachusetts General Hospital Boston Massachusetts USA
| | - Darrell Owens
- University of Washington Medical Center, UW School of Medicine Seattle Washington USA
| | - Rita Manfredi
- Department of Emergency Medicine The George Washington University School of Medicine Washington DC USA
| | - Tammie Quest
- Department of Palliative and Supportive Care Emory University Hospital Midtown, Emory University School of Medicine Atlanta Georgia USA
- Department of Family and Preventive Medicine, Department of Emergency Medicine Emory University School of Medicine Atlanta Georgia USA
| |
Collapse
|
16
|
Zaborowski N, Scheu A, Glowacki N, Lindell M, Battle-Miller K. Early Palliative Care Consults Reduce Patients' Length of Stay and Overall Hospital Costs. Am J Hosp Palliat Care 2022; 39:1268-1273. [PMID: 35061508 PMCID: PMC9527348 DOI: 10.1177/10499091211067811] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Palliative care improves health outcomes and satisfaction and supports decision-making for patients and families during challenging times in their lives. Earlier referral for consults has demonstrated increased costs savings.Hypothesis: Education proposing physicians order a palliative care consult within 3 days of patient hospital admission will decrease patient length of stay (LOS) and overall costs as well as expedite the transition to next level of care.Design/Method: A descriptive retrospective cohort study was completed using de-identified data originally captured for a system-wide initiative at a large acute care hospital in Illinois. Hospitalists were selected as the pilot group and received education encouraging physicians to order palliative care consults within 3 days of patient admission. Non-hospitalists (control group) did not receive the education. All results were compared to a 3-month baseline period.Results: A total of 711 patients were included in this study (367 baseline, 138 pilot, 206 controls). The baseline pre-consult LOS of 4.8 days was reduced to 3.7 days in the pilot group, representing a > 1 day decrease in the timing of palliative consult. The pilot demonstrated a direct cost savings of 26% over the 3-months pilot period. Additionally, a 2-day reduction in overall LOS was demonstrated in the pilot group compared to both the baseline and control groups.Conclusions: This pilot demonstrated an ability to change the timing of new palliative care consults, resulting in direct cost savings and LOS reduction. These results demonstrated the need for a larger study to confirm these findings.
Collapse
Affiliation(s)
| | - Amy Scheu
- Advocate Aurora Health, Hospice & Palliative Care, Lombard, IL, USA
| | - Nicole Glowacki
- Advocate Aurora Health, Research Institute, Downers Grove, IL, USA
| | | | | |
Collapse
|
17
|
Loffredo AJ, Chan GK, Wang DH, Goett R, Isaacs ED, Pearl R, Rosenberg M, Aberger K, Lamba S. United States Best Practice Guidelines for Primary Palliative Care in the Emergency Department. Ann Emerg Med 2021; 78:658-669. [PMID: 34353647 DOI: 10.1016/j.annemergmed.2021.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
The growing palliative care needs of emergency department (ED) patients in the United States have motivated the development of ED primary palliative care principles. An expert panel convened to develop best practice guidelines for ED primary palliative care to help guide frontline ED clinicians based on available evidence and consensus opinion of the panel. Results include recommendations for screening and assessment of palliative care needs, ED management of palliative care needs, goals of care conversations, ED palliative care and hospice consults, and transitions of care.
Collapse
Affiliation(s)
- Anthony J Loffredo
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Garrett K Chan
- Department of Physiologic Nursing, University of California, San Francisco, CA
| | - David H Wang
- Division of Palliative Medicine, Scripps Health, San Diego, CA
| | - Rebecca Goett
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Eric D Isaacs
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA
| | - Rachel Pearl
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark Rosenberg
- Department of Emergency Medicine, St Joseph's Health, Paterson and Wayne, NJ
| | - Kate Aberger
- Division of Palliative Medicine and Geriatrics, St Joseph's Health, Paterson, NJ; Department of Emergency Medicine, Robert Wood Johnson University Hospital Somerset, Somerville, NJ
| | - Sangeeta Lamba
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
| |
Collapse
|