Acceptability and Reliability of a Novel Palliative Care Screening Tool Among Emergency Department Providers

Bowman, Jason; George, Naomi; Barrett, Nina; Anderson, Kelsey; Dove-Maguire, Kalie; Baird, Janette

doi:10.1111/acem.12963

Cited by 40 publications

(37 citation statements)

References 33 publications

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“…This is similar to the usability and acceptability testing of other ED palliative care screening tools. For example, 80.5% of emergency providers who tested the P-CaRES tool felt it would be useful for their practice [12], and 70% of providers indicated a content-validated palliative care screening tool developed by Ouchi et al (2017) was acceptable [32]. In contrast, the percentage of encounters that identified palliative care needs from the CDS tool (9%) is much lower compared to the 32% positive screening found during feasibility testing of the Ouchi et al tool.…”

Section: Discussionmentioning

confidence: 99%

“…As an initial step, a scoping review of validated screening tools for unmet palliative care needs in the ED was conducted in March 2018 by author AT utilizing Pubmed. Based on the review, the Palliative Care and Rapid Emergency Screening (P-CaRES) was identified as the only screening tool to meet our search criteria and identify emergency patients with serious, life-limiting illness who could benefit from palliative care services [12]. P-CaRES consists of a two part screening process.…”

Section: Scoping Reviewmentioning

confidence: 99%

“…Providing palliative care in the ED has been demonstrated to improve quality of life, decrease intensive care unit admissions, decrease inpatient hospital length of stay, improve symptom management, and decrease cost [6][7][8][9][10][11]. However, referral to palliative care remains low, with 78.5% of emergency medicine (EM) providers reporting they refer patients with palliative care needs less than 10% of the time, and only 10.8% of providers feel they use effective methods to screen or refer patients to palliative care [12]. Emergency providers have previously identified time constraints and implementation logistics as the most challenging limitations to providing palliative care services in the ED.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Design and implementation of a clinical decision support tool for primary palliative Care for Emergency Medicine (PRIM-ER)

Tan

Durbin

Chung

et al. 2020

BMC Med Inform Decis Mak

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Background: The emergency department is a critical juncture in the trajectory of care of patients with serious, lifelimiting illness. Implementation of a clinical decision support (CDS) tool automates identification of older adults who may benefit from palliative care instead of relying upon providers to identify such patients, thus improving quality of care by assisting providers with adhering to guidelines. The Primary Palliative Care for Emergency Medicine (PRIM-ER) study aims to optimize the use of the electronic health record by creating a CDS tool to identify high risk patients most likely to benefit from primary palliative care and provide point-of-care clinical recommendations. Methods: A clinical decision support tool entitled Emergency Department Supportive Care Clinical Decision Support (Support-ED) was developed as part of an institutionally-sponsored value based medicine initiative at the Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health. A multidisciplinary approach was used to develop SupportED including: a scoping review of ED palliative care screening tools; launch of a workgroup to identify patient screening criteria and appropriate referral services; initial design and usability testing via the standard System Usability Scale questionnaire, education of the ED workforce on the SupportED background, purpose and use, and; creation of a dashboard for monitoring and feedback. Results: The scoping review identified the Palliative Care and Rapid Emergency Screening (P-CaRES) survey as a validated instrument in which to adapt and apply for the creation of the CDS tool. The multidisciplinary workshops identified two primary objectives of the CDS: to identify patients with indicators of serious life limiting illness, and to assist with referrals to services such as palliative care or social work. Additionally, the iterative design process yielded three specific patient scenarios that trigger a clinical alert to fire, including: 1) when an advance care planning document was present, 2) when a patient had a previous disposition to hospice, and 3) when historical and/or current clinical data points identify a serious life-limiting illness without an advance care planning document present. Monitoring and feedback indicated a need for several modifications to improve CDS functionality. Conclusions: CDS can be an effective tool in the implementation of primary palliative care quality improvement best practices. Health systems should thoughtfully consider tailoring their CDSs in order to adapt to their unique workflows and environments. The findings of this research can assist health systems in effectively integrating a primary palliative care CDS system seamlessly into their processes of care.

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Section: Discussionmentioning

confidence: 99%

Section: Scoping Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Design and implementation of a clinical decision support tool for primary palliative Care for Emergency Medicine (PRIM-ER)

Tan

Durbin

Chung

et al. 2020

BMC Med Inform Decis Mak

View full text Add to dashboard Cite

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“…There are a number of these, one example is represented in Table . Recent research has shown that the use of one such list is acceptable and reliable in the ED setting …”

Section: Initiating Planning In the Patient Approaching End‐of‐lifementioning

confidence: 99%

“…[17][18][19][20] Recent research has shown that the use of one such list is acceptable and reliable in the ED setting. 21 Emergency physicians have a critical circuit breaker role in: (i) identifying patients who would benefit from formal advance care planning; and then (ii) raising the issue at the appropriate time in a non-threatening way. 22 Beyond this, it is generally impossible to complete such complex planning in the ED setting.…”

Section: Initiating Planning In the Patient Approaching End-of-lifementioning

confidence: 99%

Approach to death in the older emergency department patient

Arendts

Carpenter

Hullick

et al. 2016

Emerg Medicine Australasia

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Geriatric End-of-Life Screening Tool Prediction of 6-Month Mortality in Older Patients

Haimovich,

Burke,

Nathanson

et al. 2024

JAMA Netw Open

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ImportanceEmergency department (ED) visits by older adults with life-limiting illnesses are a critical opportunity to establish patient care end-of-life preferences, but little is known about the optimal screening criteria for resource-constrained EDs.ObjectivesTo externally validate the Geriatric End-of-Life Screening Tool (GEST) in an independent population and compare it with commonly used serious illness diagnostic criteria.Design, Setting, and ParticipantsThis prognostic study assessed a cohort of patients aged 65 years and older who were treated in a tertiary care ED in Boston, Massachusetts, from 2017 to 2021. Patients arriving in cardiac arrest or who died within 1 day of ED arrival were excluded. Data analysis was performed from August 1, 2023, to March 27, 2024.ExposureGEST, a logistic regression algorithm that uses commonly available electronic health record (EHR) datapoints and was developed and validated across 9 EDs, was compared with serious illness diagnoses as documented in the EHR. Serious illnesses included stroke/transient ischemic attack, liver disease, cancer, lung disease, and age greater than 80 years, among others.Main Outcomes and MeasuresThe primary outcome was 6-month mortality following an ED encounter. Statistical analyses included area under the receiver operating characteristic curve, calibration analyses, Kaplan-Meier survival curves, and decision curves.ResultsThis external validation included 82 371 ED encounters by 40 505 unique individuals (mean [SD] age, 76.8 [8.4] years; 54.3% women, 13.8% 6-month mortality rate). GEST had an external validation area under the receiver operating characteristic curve of 0.79 (95% CI, 0.78-0.79) that was stable across years and demographic subgroups. Of included encounters, 53.4% had a serious illness, with a sensitivity of 77.4% (95% CI, 76.6%-78.2%) and specificity of 50.5% (95% CI, 50.1%-50.8%). Varying GEST cutoffs from 5% to 30% increased specificity (5%: 49.1% [95% CI, 48.7%-49.5%]; 30%: 92.2% [95% CI, 92.0%-92.4%]) at the cost of sensitivity (5%: 89.3% [95% CI, 88.8-89.9]; 30%: 36.2% [95% CI, 35.3-37.1]). In a decision curve analysis, GEST outperformed serious illness criteria across all tested thresholds. When comparing patients referred to intervention by GEST with serious illness criteria, GEST reclassified 45.1% of patients with serious illness as having low risk of mortality with an observed mortality rate 8.1% and 2.6% of patients without serious illness as having high mortality risk with an observed mortality rate of 34.3% for a total reclassification rate of 25.3%.Conclusions and RelevanceThe findings of this study suggest that both serious illness criteria and GEST identified older ED patients at risk for 6-month mortality, but GEST offered more useful screening characteristics. Future trials of serious illness interventions for high mortality risk in older adults may consider transitioning from diagnosis code criteria to GEST, an automatable EHR-based algorithm.

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Acceptability and Reliability of a Novel Palliative Care Screening Tool Among Emergency Department Providers

Cited by 40 publications

References 33 publications

Design and implementation of a clinical decision support tool for primary palliative Care for Emergency Medicine (PRIM-ER)

Design and implementation of a clinical decision support tool for primary palliative Care for Emergency Medicine (PRIM-ER)

Approach to death in the older emergency department patient

Geriatric End-of-Life Screening Tool Prediction of 6-Month Mortality in Older Patients

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