A Rapid Two-Stage Screening Protocol for Palliative Care in the Emergency Department: A Quality Improvement Initiative

Abstract

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.

Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs

“…Unlike previously published PC screening tools, this one should not require a provider to perform an additional patient interview, nor should it require a PC specialist or case manager for completion. 15,69,70,72 Ultimately, for this screening tool to increase rates of PC consultation as well as decrease the long latency between hospital admission and PC consultation, the results of the screening tool must be put to use. Multiple interventions based on this screening tool are conceivable.…”

“…All ED PC referral or integration projects that we examined had some measure of success in terms of increasing PC evaluation and referral from the ED. [69][70][71][72][73] Common weaknesses of prior efforts included absence of evidenced-based development of an ED-specific screening tool, narrow inclusion criteria (i.e., cancer patients only), use of lengthy PC patient assessment tools, and reliance on additional staff to perform screening.…”

Determining the need for palliative care in the emergency department: A feasibility study

“…[14] Previously the ED has not been considered a conducive environment for the integration of PC services, however benefits have started to emerge as to the potential impact of starting PC in the ED. [12,15,16] Additionally, the emergence and reinforcement of the concept that curative treatment and palliation can and should occur simultaneously has PC being viewed applicable to a wider scope of health care settings. [17,18] The Improving Palliative Care in Emergency Medicine (IPAL-EM) Project by the CAPC was created in response to recognizing that the ED provided a unique opportunity to initiate PC.…”

Emergency Medicine and Palliative Care

“…The perception that palliative care takes too much time Fear of litigation if interventions are withheld Lack of access to medical records or advanced care planning documents or an inability of patients to otherwise communicate what their goals are Availability of palliative care consults in the ED, although even in centers with robust palliative care consult teams, there is still marked underuse of this service in the ED 21 Lack of privacy/physical design layout of the ED not conducive to palliative care approach 22 Sense of conflict between mission of ED and palliative care 9 Failure to recognize which patients may benefit from a palliative care consult 23,24 A sense of discomfort with withholding or withdrawing life-sustaining interventions Inexperience with leading discussions regarding options that may include palliative or hospice care A significant percentage of residents never receive direct supervision or observation when conducting family meetings or delivering bad news and suffer from a sense of failure or guilt when caring for dying patients 25 Lack of knowledge of basic palliative care interventions 26 …”