Determining the need for palliative care in the emergency department: A feasibility study

Abstract

Background: According to the Centers for Disease Control and Prevention (CDC), there are over 136 million emergency department (ED) visits annually with increasing use and overcrowding of the ED. The ED’s fast paced, often aggressive treatment nature can provide considerable obstacles to achieving desired benchmarks of quality patient and family centered care that shows improved outcomes along with high levels of satisfaction. Recognizing the need for palliative care (PC) in emergency medicine to facilitate better care, the Center to Advance Palliative Care (CAPC) developed the Improving Palliative Care in Emergency Medicine (IPAL-EM) Project.
Methods: A retrospective review of an integrated data repository (IDR) was completed to determine the feasibility, design, and implementation of a PC protocol in the ED of a large, academic Level I Trauma Center. The IPAL-EM Project’s recommendations were explored as we targeted trauma-alert and traumatic intracerebral hemorrhage (ICH) patients.
Results: The protocol identified 719 patient encounters over an eight month time-frame that would have triggered an ED initiated PC consultation. Using Meier’s average per-patient per-admission net cost savings related to PC of $2,659 per encounter, there was a potential for over $1.9 million in savings for the facility.
Conclusions: PC has demonstrated numerous benefits in various healthcare settings. Studies describing PC in the ED are limited. Furthermore, its culture was not viewed as conducive to PC incorporation. However, future studies investigating the impact of PC on length of stay (LOS), symptom management, patient/family satisfaction, and costs of care is critical.