169 Palliative Consultations from the Emergency Department Reduce Inpatient Length of Stay and Costs

Abstract

evaluated the curriculum using a standardized assessment and review tool. In phase IV, the detailed feedback was used to refine the curriculum further.Results: Phases I to III have been completed. Phase IV will be completed in late 2019. The draft curriculum has 8 non-clinical sections and 10 clinical sections: (1) Introduction to the Human Body; (2) Patient Assessment; (3) Resuscitation; (4) Trauma; (5) Medical Emergencies (6) Pediatrics; (7) Obstetrics and Neonatal Care; (8) Toxicological and Environmental Emergencies; (9) Special Populations; ( 10) Clinical Skills. A third section outlines the necessary clinical experience for each trainee. The rationale for this structure is to ensure that providers have a solid medical knowledge foundation for further training programs. It was also apparent during the phase I review of existing curriculums and the phase II expert panel discussions that this course should contain enough non-clinical elements to ensure that providers have basic operational knowledge such as vehicle operations and hand tool extrication techniques.Conclusion: An Africa-specific BLS curriculum will be produced through this expert consensus process. Subsequently, the final BLS curriculum will be linked to a repository of educational materials and applied to 'real-world' BLS provider training to ensure it meets its objective of being context specific and resource appropriate for Africa.

An Assessment of Emergency Department-Based Interventions for Patients with Advanced or End-Stage Illness: A Systematic Review

“…For the impact of PC interventions on LOS, a pooled meta-analysis was not possible as the majority of studies assessing LOS did not report any measures of variance for the intervention or control groups. 10,[17][18][19][20] Furthermore, the three studies that did report measures of variance each utilized a different study design, further limiting the ability to pool. 8,9,11 Finally, the units of time used across the studies varied between minutes and days.…”

“…21,22 In some cases, the 95% CI for the RoM of a particular study could not be calculated due to insufficient information provided by the study authors. 10,[18][19][20] The 95% CI was estimated in one study that did not report standard deviation but reported the p-value. 17 Due to methodological and clinical heterogeneity, pooling of the RoMs was not completed.…”

“…The included studies consisted of six unique RCTs, 9,17,[25][26][27][28] seven before/after studies, 10,[29][30][31][32][33][34] and five controlled observational cohorts 8,11,[18][19][20] (Table 1). Three of the included studies were protocols for ongoing clinical trials in which no outcome data were available for extraction.…”

“…25,26,28 At least 4625 patients were enrolled across the studies; however, five of the included studies did not report the number of enrolled patients. 19,30,31,33,34 The target patient population varied considerably across the studies (Table 1). Some studies specified that they enrolled patients with specific EOL conditions, including advanced cancer, 9,11,29 advanced cancer/end-stage organ failure, 25 or advanced dementia/critical illness.…”

“…18,30 Some studies allowed patients with any unspecified advanced illness to participate in the study, or reported to including any patients who underwent palliative services. 8,10,19 See Table 1 for additional information on the PC interventions implemented in the included studies. While the exact nature of the interventions varied among the studies, the majority of studies (n = 14) assessed the impact of early requests for PC consultations in the ED.…”