Not One More Thing

Abstract

Palliative care consultation in the emergency department (ED) can be helpful to ED teams, patients, and families alike. The emergency clinician may, through a more objective approach, be able to identify unmet palliative care needs, such as functional debility, symptom burden, and lack of prognostic awareness. Earlier palliative care involvement has been shown to significantly decrease hospital length of stay and cost, and it has demonstrated marked improvements in depression, anxiety, and well-being across multiple disease states. Subspecialty palliative care consultation in the ED can be helpful in several ways. First, it can assist with gaining a broader view of the clinical course and gather additional history and perspective that might not have been gained through coordination with other providers or additional historians. Consultants can help clarify a patient’s goals of care, assist with difficult symptom management, and help provide guidance on patients enrolled in hospice or with hospice enrollment from the ED. Palliative care consultants can also assist in disposition determination and help to create safe discharge and follow-up plans. There is a spectrum of models for how palliative care can support the ED, ranging from “as needed” palliative consultation by standard ED practice, to dedicating and embedding a multidisciplinary palliative care team into the ED.