The project shows unmet needs among elderly ED patients, and the feasibility of rapid screening and referral using a quality improvement approach. At its peak, the project accounted for half the referrals to the palliative care consultation service.

Mesenteric ischemia is an uncommon disease most often seen in the elderly. This disease results from blood flow in the mesenteric circulation that inadequately meets metabolic needs of the visceral organs and, if untreated, eventually leads to necrosis of the bowel wall. Mesenteric ischemia is divided into 2 types: acute mesenteric ischemia (AMI) and chronic mesenteric ischemia (CMI). Delayed diagnosis of CMI can lead to AMI. AMI is associated with extremely high mortalities. Early diagnosis via computed tomography angiography and prompt revascularization via endovascular therapy are recommended for symptomatic patients who have not developed bowel ischemia and necrosis.

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Recognizing that seriously ill patients and their families utilize emergency departments (EDs) for distressing symptoms, changing goals of care, or at the end of life, palliative care and emergency medicine departments are partnering to enhance the care provided to patients with life-limiting illnesses and their families. A social work model for identifying patients with unmet palliative care needs in the ED is included to illustrate the process as well as specific psychosocial interventions that palliative social workers can provide in this environment. As increasing numbers of palliative and emergency medicine departments partner to both improve ED care for patients with life-threatening illness and initiate palliative care consults earlier in hospitalizations, palliative and ED social workers have an opportunity to join their physician and nurse colleagues who are making inroads in this important and growing area.