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

Abstract

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.

Emerging Palliative Care Innovations in the ED: A Qualitative Analysis of Programmatic Elements During the COVID-19 Pandemic

“…This builds on prior single site data suggesting that ED clinicians find increased PC presence better both for their patients and for their own wellbeing. 26 Our study further suggests that the experience of the PC clinicians was also largely positive. It is important to note that one site raised a theoretical concern related to PC involvement in the ED resulting in increased ED length of stay.…”

“…In several models, a variety of providers were brought into the ED to facilitate GOC conversations while allowing ED providers to prioritize their other duties. Previous work has reported on ED providers interest in being freed from this time-intensive task during COVID, 26 and embedding non-ED clinicians in the ED to have these conversations may hold promise.…”

Palliative Care for Patients on Extracorporeal Membrane Oxygenation for COVID-19 Infection

“…The benefits of an “embedded” palliative care team for hospital units caring for a high number of critically ill patients with COVID-19 may be even greater, as evidenced in one study of emergency department providers. 35 Based on this evidence, we recommend involvement of palliative care for patients/families with COVID-19 infection who are on ECMO.…”

Primary and Specialist-Level Palliative Care during the spring 2020 COVID-19 Surge: A Single-Center Experience in the Bronx

“…Survey respondents noted that the time constraints usually faced by ED providers were only amplified during COVID; they appreciated that palliative care specialists could afford longer, higher-quality discussions that more fully elicited patient and family goals. 10 The style of questioning promoted by a script, exacerbated by overwhelming patient volume in disaster circumstances, risks removing the sensitivity essential in approaching end-of-life matters. In addition to time, palliative care encompasses allied care workers that provide spiritual, psychological, and bereavement support.…”