Palliative care in the emergency department during a COVID-19 pandemic

Eygnor, Jessica K; Rosenau, Alexander M.; Burmeister, David B.; Richardson, David M.; DePuy, Amy M.; Kayne, Allison N.; Greenberg, Marna Rayl

doi:10.1016/j.ajem.2020.07.004

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…ED physicians carry many additional responsibilities, including diagnosis, resuscitation, and triage within the hospital, and thus aspects of some ACP activities remain outside the scope of routine emergency medicine practice. 16 , 17 Conversely, the significant uptake in ED documentation of HCDM demonstrates that there are aspects of ACP that can easily and reliably be incorporated into an ED physician workflow. Further, the increase in uptake of ED-based ACP among patients stable for discharge demonstrates that emergency physicians can have a role in defining care preferences outside of time-sensitive decisions confronted in the management of critical illness.…”

Section: Discussionmentioning

confidence: 99%

Advance Care Planning for Emergency Department Patients With COVID-19 Infection: An Assessment of a Physician Training Program

Casey

Price

Markwalter

et al. 2022

Am J Hosp Palliat Care

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Objective Coronavirus Disease 2019 (COVID-19) has heightened the importance of advance care planning (ACP), particularly in the emergency department (ED). The objective of this study was to determine the effect of an educational program for emergency physicians on ACP conversations in the ED during the COVID-19 pandemic. Design This was an observational pre-/post-interventional study. Setting This study was conducted at a Southeastern U.S. academic ED. Participants 143 patients with confirmed COVID-19 infection in the 2 weeks up to and including the ED encounter of interest (between March 26 and May 25, 2020) were included. Interventions The primary intervention was an ACP training toolkit with three components: (1) an evidence-based guide to COVID-19 risk stratification, (2) education on language to initiate ACP conversations, and (3) modification of the electronic health record (EHR) to facilitate ACP documentation. Palliative care physicians also delivered a 60-minute ACP educational session for emergency medicine physicians. Outcome measures The primary outcome was a composite of ACP activities including: (1) identification of a healthcare decision-maker (HCDM), (2) an order for a code status, or (3) a documented goals of care conversation. Results There was a 25.4% (95% CI: 7.0-43.9) increase in the composite outcome of ED-based ACP. After adjustment for patient demographics and triage score, there was a non-statistically significant increase in ACP activity (OR = 2.71, 95% CI: 0.93-8.64; P = .08). Conclusion A rapid and simple physician-facing educational intervention demonstrated a trend, though lacking in statistical significance, towards increased ED-based ACP activities for patients with COVID-19.

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Section: Discussionmentioning

confidence: 99%