An Emergency Department Clinical Algorithm to Increase Early Palliative Care Consultation: Pilot Project

Denney, C.; Duan, Yuchen; O'Brien, PE; Peach, Daniel J; Lanier, Shelley; Lopez, Joshua A.; Buxton, D.; Maulfair, Mitchell Dean; Kuhlman, Jeffrey; Ahmad, Sarfraz; Helmstetter, Kyle

doi:10.1089/jpm.2020.0750

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…42,43 Other programs have assessed ED palliative care consultations with different staffing models, including APPs, social workers, and a multidisciplinary palliative care team. 41,44,45 The impact of these programs was typically measured by the effect on health care use; few studies measured patient-oriented outcomes. 41,44 The COVID-19 pandemic resulted in further growth in ED palliative care services.…”

Section: Ed-based Palliative Care Modelsmentioning

confidence: 99%

“…A program of ED‐triggered inpatient palliative care consultations demonstrated that early palliative care consultation may result in decreased hospital lengths of stay and costs of care 42,43 . Other programs have assessed ED palliative care consultations with different staffing models, including APPs, social workers, and a multidisciplinary palliative care team 41,44,45 . The impact of these programs was typically measured by the effect on health care use; few studies measured patient‐oriented outcomes 41,44 …”

Section: Introductionmentioning

confidence: 99%

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Developing a novel integrated geriatric palliative care consultation program for the emergency department

et al. 2022

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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.

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Section: Ed-based Palliative Care Modelsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Developing a novel integrated geriatric palliative care consultation program for the emergency department

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The literature on palliative care in EDs is emerging and the recommendations are modest and very recent (2017–2021) [ 16 , 27 – 29 ]. Despite the limited number of studies and the lack of uniformity in the palliative interventions carried out in the ED, they are showing initial positive effects for the patient and the health care system, such as: improvement of the quality of life without reducing it [ 30 ], reduction in length of hospital stays [ 28 ], reduction in the number of technical examinations (imaging) and costs [ 31 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

Is palliative care a utopia for older patients with organ failure, dementia or frailty? A qualitative study through the prism of emergency department admission

Bourmorck,

Pétré,

de Saint-Hubert

et al. 2024

BMC Health Serv Res

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Background Nearly three out of four older people will use the emergency department (ED) during their last year of life. However, most of them do not benefit from palliative care. Providing palliative care is a real challenge for ED clinicians who are trained in acute, life-saving medicine. Our aim is to understand the ED’s role in providing palliative care for this population. Methods We designed a qualitative study based on 1) interviews – conducted with older patients (≥ 75 years) with a palliative profile and their informal caregivers – and 2) focus groups – conducted with ED and primary care nurses and physicians. Palliative profiles were defined by the Supportive and Palliative Indicators tool (SPICT). Qualitative data was collected in French-speaking Belgium between July 2021 and July 2022. We used a constant inductive and comparative analysis. Results Five older patients with a palliative profile, four informal caregivers, 55 primary and ED caregivers participated in this study. A priori, the participants did not perceive any role for the ED in palliative care. In fact, there is widespread discomfort with caring for older patients and providing palliative care. This is explained by multiple areas of tensions. Palliative care is an approach fraught with pitfalls, i.e.: knowledge and know-how gaps, their implementation depends on patients’(co)morbidity profile and professional values, experiences and type of practice. In ED, there are constant tensions between emergency and palliative care requirements, i.e.: performance, clockwork and needs for standardised procedures versus relational care, time and diversity of palliative care projects. However, even though the ED’s role in palliative care is not recognised at first sight, we highlighted four roles assumed by ED caregivers: 1) Investigator, 2) Objectifier, 3) Palliative care provider, and 4) Decision-maker on the intensity of care. A common perception among participants was that ED caregivers can assist in the early identification of patients with a palliative profile. Conclusions Currently, there is widespread discomfort regarding ED caregivers caring for older patients and providing palliative care. Nonetheless, ED caregivers play four roles in palliative care for older patients. In the future, ED caregivers might also perform the role of early identifier.

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“…The literature on palliative care in EDs is emerging and the recommendations are modest and very recent (2017-2021) (24)(25)(26)(27). Despite the limited number of studies and the lack of uniformity in the palliative interventions carried out in the ED, they are showing initial positive effects for the patient and the health care system, such as: improvement of the quality of life without reducing it (28), reduction in length of hospital stays (25), reduction in the number of medical examinations (imaging) and costs (29,30).…”

mentioning

confidence: 99%

Is palliative care a utopia for older patients with organ failure, dementia or frailty? A qualitative study through the prism of emergency department admission

Bourmorck,

Pétré,

de Saint-Hubert

et al. 2024

Preprint

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Background Nearly three out of four older people will use the emergency department (ED) during their last year of life. However, most of them do not benefit from palliative care. Providing palliative care is a real challenge for ED clinicians who are trained in acute, life-saving medicine. Our aim is to understand the ED’s role in providing palliative care for this population. Methods We designed a qualitative study based on 1) interviews – conducted with older patients (≥75 years) with a palliative profile and their informal caregivers – and 2) focus groups – conducted with ED and primary care nurses and physicians. Palliative profiles were defined by the Supportive and Palliative Indicators tool (SPICT). Qualitative data was collected in French-speaking Belgium between July 2021 and July 2022. We used a constant inductive and comparative analysis. Results Five older patients with a palliative profile, four informal caregivers, 55 primary and ED caregivers participated in this study. A priori, the participants did not perceive any role for the ED in palliative care. In fact, there is a widespread discomfortwith caring for older patients and providing palliative care. This is explained by multiple areas of tensions. Palliative care is an approach fraught with pitfalls, i.e.: knowledge and know-how gaps, their implementation depends on patients’(co)morbidity profile and professional values, experiences and type of practice. In ED, there are constant tensions between emergency and palliative care requirements, i.e.: performance, clockwork and needs for standardised procedures versus relational care, time and diversity of palliative care projects. However, even though the ED’s role in palliative care is not recognised at first sight, we highlighted four roles assumed by ED caregivers: 1) Investigator, 2) Objectifier, 3) Palliative care provider, and 4) Decision-maker on the intensity of care. Their main perspective is that ED caregivers could be the identifiers of early palliative profile. Conclusions Even if there are still major obstacles to implementing palliative care for older patients upon admission to the emergency department, ED caregivers already assume certain roles, although they do not recognise them as such. In the future, ED caregivers might also endorse the role of early identifier.

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An Emergency Department Clinical Algorithm to Increase Early Palliative Care Consultation: Pilot Project

Cited by 7 publications

References 19 publications

Developing a novel integrated geriatric palliative care consultation program for the emergency department

Developing a novel integrated geriatric palliative care consultation program for the emergency department

Is palliative care a utopia for older patients with organ failure, dementia or frailty? A qualitative study through the prism of emergency department admission

Is palliative care a utopia for older patients with organ failure, dementia or frailty? A qualitative study through the prism of emergency department admission

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