Past, present, and future of palliative care in emergency medicine in the USA

George, Naomi; Bowman, Jason; Aaronson, Emily; Ouchi, Kei

doi:10.1002/ams2.497

Cited by 44 publications

(39 citation statements)

References 47 publications

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“…4 Accordingly, there is consensus among emergency medicine's professional societies that increasing PC research and presence in the ED is important. 5,6 The American Board of Internal Medicine's Choosing Wisely Campaign includes recommendations not to delay in engaging available palliative and hospice services in the ED for patients likely to benefit. 7 In the setting of coronavirus disease (COVID), this need has intensified.…”

Section: Introductionmentioning

confidence: 99%

The Experience of Emergency Department Providers With Embedded Palliative Care During COVID

Aaronson

Petrillo

Stoltenberg

et al. 2020

Journal of Pain and Symptom Management

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Introduction Although the importance of palliative care (PC) integration in the Emergency Department (ED) has long been recognized, few formalized programs have been reported and none have evaluated the experience of ED clinicians with embedded PC. We evaluate the experience of ED clinicians with embedded PC in the ED during COVID. Methods ED clinicians completed a survey about their perceptions of embedded PC in the ED. We summarized responses to closed-ended items using descriptive statistics and analyzed open-ended items using thematic analysis. Results There were 134 ED clinicians surveyed. 101 replied (75% response rate). Of those that had interacted with PC, 100% indicated a benefit of having PC involved. These included freeing up ED clinicians for other tasks (89%), helping them feel more supported (84%), changing the patients care trajectory (67%), and contributing to clinician education (57%) and skills (49%). Among barriers related to engaging PC were difficulty locating them (8%) and lack of time to consult due to ED volume (5%). 98% of respondents felt that having PC in the ED was either “valuable” or “very valuable.” Open-ended responses reflected a positive impact on clinician wellness and improvement in access to high quality goal concordant care. Clinicians expressed gratitude for having PC in the ED and noted the importance of having readily available and easily accessible PC in the ED. Conclusion ED clinicians’ perception of embedded PC was overall positive, with an emphasis on the impact related to task management, enrichment of PC skills, providing support for the team, and improved care for ED patients.

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Section: Introductionmentioning

confidence: 99%

The Experience of Emergency Department Providers With Embedded Palliative Care During COVID

Aaronson

Petrillo

Stoltenberg

et al. 2020

Journal of Pain and Symptom Management

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“…Multiple studies found that an ED-initiated PC consultation can determine benefits on outcomes in serious chronic patients, e.g., significantly shorter length of stay [ 52 ], improved QOL without shortening survival [ 53 ], and timely referral to community, inpatient PC teams, or hospice services [ 54 , 55 ].…”

Section: Resultsmentioning

confidence: 99%

Caring for Patients in Need of Palliative Care: Is This a Mission for Acute Care Hospitals? Key Questions for Healthcare Professionals

Cotogni

Luca

2022

Healthcare

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The prevalence of patients affected by end-stage diseases or advanced cancer is increasing due to an aging population and progression in medicine and public healthcare. The burden of symptoms these people suffer in the last months of life often forces them to seek aid in an emergency department. In developed countries, acute care hospital-based services are often better designed to treat acute clinical conditions than to manage the needs of patients with serious chronic diseases. Thus, the palliative care (PC) population poses very real clinical challenges to healthcare professionals who care for them in hospital settings. The authors have formulated four key questions (who, why, when, and how) to address in order to identify a model for providing the best care for these PC patients. The questions are related to: (1) defining people living with serious chronic diseases; (2) managing the challenge of unplanned hospital admission of these people; (3) identifying PC patients among people with serious chronic diseases; and (4) determining the appropriate work of caring for this inpatient PC population. Clinicians need the knowledge, tools, and services to care for these PC patients, and acute care hospitals should plan the work of caring for these inpatients.

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“…Nowadays, as palliative care is recognized as a legitimate purpose of the ED, ED clinicians are more likely to initiate palliative care referrals, discuss palliative care concerns, and provide information and clarification [ 51 ]. As George et al suggested [ 14 ], substantial work is yet to be done in terms of identifying ED patients in need of palliative care, training emergency medicine clinicians to provide high-quality primary palliative care, creating pathways to ED referrals for palliative care, and researching the outcomes and impact of palliative care provision on patients with serious illness in the ED. A previous study indicated that des pite surprise questions facilitating advance care planning discussions in the ED setting, the reliability of responses was a concern to physicians [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although not initially considered the best setting for palliative care referral, the ED may identify early signs of palliative care needs upon early emergency visits, and on the other hand, may also be the last opportunity for patients to initiate palliative care. Thus, the realization of the importance of palliative care referral in the ED has gradually come to light [ 14 ]. Due to the unique environment of the ED, quick and precise assessments of patients are highly demanded.…”

Section: Introductionmentioning

confidence: 99%

Emergency Department Referral for Hospice and Palliative Care Differs among Patients with Different End-of-Life Trajectories: A Retrospective Cohort Study

Shen

Yang

Lai

et al. 2021

IJERPH

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Emergency units have been gradually recognized as important settings for palliative care initiation, but require precise palliative care assessments. Patients with different illness trajectories are found to differ in palliative care referrals outside emergency unit settings. Understanding how illness trajectories associate with patient traits in the emergency department may aid assessment of palliative care needs. This study aims to investigate the timing and acceptance of palliative referral in the emergency department among patients with different end-of-life trajectories. Participants were classified into three end-of-life trajectories (terminal, frailty, organ failure). Timing of referral was determined by the interval between the date of referral and the date of death, and acceptance of palliative care was recorded among participants eligible for palliative care. Terminal patients had the highest acceptance of palliative care (61.4%), followed by those with organ failure (53.4%) and patients with frailty (50.1%) (p = 0.003). Terminal patients were more susceptible to late and very late referrals (47.4% and 27.1%, respectively) than those with frailty (34.0%, 21.2%) and with organ failure (30.1%, 18.8%) (p < 0.001, p = 0.022). In summary, patients with different end-of-life trajectories display different palliative care referral and acceptance patterns. Acknowledgement of these characteristics may improve palliative care practice in the emergency department.

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Past, present, and future of palliative care in emergency medicine in the USA

Cited by 44 publications

References 47 publications

The Experience of Emergency Department Providers With Embedded Palliative Care During COVID

The Experience of Emergency Department Providers With Embedded Palliative Care During COVID

Caring for Patients in Need of Palliative Care: Is This a Mission for Acute Care Hospitals? Key Questions for Healthcare Professionals

Emergency Department Referral for Hospice and Palliative Care Differs among Patients with Different End-of-Life Trajectories: A Retrospective Cohort Study

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