Emergency Medicine and Palliative Care

Lowery, Derrick; Quest, Tammie E.

doi:10.1016/j.cger.2015.01.009

Cited by 18 publications

(18 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…To optimally deliver primary palliative care in the ED, patients who could benefit from these services must be quickly, and accurately, identified. Existing tools to efficiently identify patients who may benefit from palliative care in high-acuity settings are currently limited to multitier screening tools which involve additional staffing to assist in patient identification, or rely heavily on emergency provider judgement [16][17][18]. With the pervasiveness of electronic health records (EHR), institutions can leverage electronic clinical decision support (CDS) to assist providers in identifying patients most likely to benefit from primary palliative care and provide point-of-care clinical recommendations [19,20].…”

Section: Introductionmentioning

confidence: 99%

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

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

show abstract

“…One consequence of this is growing use of Emergency Departments (ED) by older palliative patients towards the end of their lives (Albert et al, 2013, Blackwell and Grudzen, 2014, Lowery and Quest, 2015. The nature of the ED makes visits challenging for such patients, family members and staff alike.…”

Section: Introductionmentioning

confidence: 99%

Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes

Blackwell

Lowton

Robert

et al. 2017

International Journal of Nursing Studies

120

View full text Add to dashboard Cite

Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: a reflective critique on the process and outcomes.International Journal of Nursing Studies http://dx.doi.org/10. 1016/j.ijnurstu.2017.01.002 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. palliative needs has led to the development of several service-level interventions intended to improve care quality. There is little evidence of patient and family involvement in developmental processes, and little is known about the experiences of -and preferences for -palliative care delivery in this setting. Participatory action research seeking to enable collaborative working between patients and staff should enhance the impact of local quality improvement work but has not been widely implemented in such a complex setting.Objectives: To critique the feasibility of this methodology as a quality improvement intervention in complex healthcare settings, laying a foundation for future work.Setting: an Emergency Department in a large teaching hospital in the United Kingdom.Methods: Experience-based Co-design incorporating: 150 hours of nonparticipant observation; semi-structured interviews with 15 staff members about their experiences of palliative care delivery; 5 focus groups with 64 staff members to explore challenges in delivering palliative care; 10 filmed semi-structured interviews with palliative care patients or their family members; a co-design event involving staff, patients and family members.Findings: the study successfully identified quality improvement priorities leading to changes in Emergency Department-palliative care processes. Further outputs were the creation of a patientfamily-staff experience training DVD to encourage reflective discussion and the identification and application of generic design principles for improving palliative care in the Emergency Department. There were benefits and challenges associated with using Experience-based Codesign in this setting. Benefits included the flexibility of the approach, the high levels of engagement and responsiveness of patients, families and staff, and the impact of using filmed narrative interviews to enhance the 'voice' of seldom heard patients and families. Challenges included high levels of staff turnover during the 19 month project, significant time constraints in the Emergency Department and the ability of older patients and their families to fully participate in the co-design process.Conclusion: Experience-based Co-design is a useful approach for encouraging collaborative working between vulnerable p...

show abstract

“…It was critical that the process involve a de novo creation of relevant content topics by literature review and consensus from educational leaders in the field of EM and HPM, as there is no standardized HPM curriculum for EM. In addition to literature review, the committee reviewed core EM textbooks through 2014, emergency medicine and palliative care clinical practice guidelines, palliative care perspectives within adjoining disciplines (pediatrics, internal medicine, family medicine), geriatrics and EM, as well as expert advisory panel discussion. Twenty‐three content topics under three domains were agreed upon and were used extensively in the subsequent development of the HPM‐EM milestones .…”

Section: Methodsmentioning

confidence: 99%

Development of Hospice and Palliative Medicine Knowledge and Skills for Emergency Medicine Residents: Using the Accreditation Council for Graduate Medical Education Milestone Framework

Shoenberger

Lamba

Goett

et al. 2018

AEM Education and Training

View full text Add to dashboard Cite

show abstract

Emergency Medicine and Palliative Care

Cited by 18 publications

References 24 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)

Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes

Development of Hospice and Palliative Medicine Knowledge and Skills for Emergency Medicine Residents: Using the Accreditation Council for Graduate Medical Education Milestone Framework

Contact Info

Product

Resources

About