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Older patients with advanced illnesses are presenting more frequently to emergency departments (EDs).
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These patients have complex needs that challenge busy EDs tuned to provide emergent, life-sustaining interventions and rapid dispositions.
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Matching the appropriate level of medical intervention to a patient’s goals of care requires specialized communication skills.
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Providing comfort at the end of life requires the ability to manage the following situations in the acutely dying patient: acute pain,
Care of Geriatric Patients with Advanced Illnesses and End-of-Life Needs in the Emergency Department
Section snippets
Key points
Screening of emergency department patients for palliative care needs
It is known that patients with advanced illness are at risk for not getting the care they want at the end of life.15 Given the resource limitations of EDs, it is critical to identify which patients would benefit most from a palliative care intervention.
Two patient presentations in the ED requiring palliative care predominate16:
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Likely terminal event (massive stroke, cardiac event, or surgical emergency): palliative care in the ED addresses of end-of-life care, including its provision,
What are the barriers to palliative care in the emergency department?
For ED providers who are on the front line in caring for people with advanced illness, there are multiple barriers to the initiation of palliative-centered care, ranging from goals of care discussions to comfort oriented care at the end of life. Reported obstacles include (1) lack of readily accessible palliative care consultation services 24/7, (2) incomplete medical records and patient information to aid in prognostication and inform goals of care discussions, (3) communication and training
Providing palliative care in the emergency department
Three core skills ED providers need to deliver palliative care in the ED are discussed: (1) screening for palliative care needs, (2) communicating effectively with patients and families, and (3) managing palliative care symptoms for acutely ill or actively dying patients.
Summary
ED providers represent the front line for providing palliative care to the sickest and most vulnerable patients. Although the ED may not traditionally be designed to meet these needs, ED providers have a great opportunity to identify patients with palliative care needs and initiate goal-oriented palliative services that can have an impact on patient care dramatically. By screening for needs assessments, using specialized communication techniques, attending to symptom management at the end of
References (38)
- et al.
Does palliative care have a future in the emergency department? Discussions with attending emergency physicians
J Pain Symptom Manage
(2012) - et al.
Palliative care screening and assessment in the emergency department: a systematic review
J Pain Symptom Manage
(2016) - et al.
Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango)
Soc Sci Med
(1997) - et al.
Choices of seriously ill patients about cardiopulmonary resuscitation: correlates and outcomes. SUPPORT investigators. Study to understand prognoses and preferences for outcomes and risks of treatments
Am J Med
(1996) - et al.
Place of care in advanced cancer: a qualitative systematic literature review of patient preferences
J Palliat Med
(2000) - et al.
Palliative care provision in the emergency department: barriers reported by emergency physicians
J Palliat Med
(2013) - et al.
Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there
Health Aff (Millwood)
(2012) - et al.
Palliative care needs of seriously ill, older adults presenting to the emergency department
Acad Emerg Med
(2010) - Physicians ACoE. Choosing Wisely 2016. Secondary Choosing Wisely 2016. Available at: http://www.choosing...
- et al.
Emergency department-initiated palliative care in advanced cancer: a randomized clinical trial
JAMA Oncol
(2016)
Quality end-of-life care: patients' perspectives
JAMA
Fast response is key to partnering with the emergency department
J Palliat Med
Early goal-directed palliative therapy in the emergency department: a step to move palliative care upstream
J Palliat Med
Hospital-based palliative care consultation: effects on hospital cost
J Palliat Med
Making the case for palliative care at the system level: outcomes data
J Palliat Med
Economic impact of hospital inpatient palliative care consultation: review of current evidence and directions for future research
J Palliat Med
Effects of initiating palliative care consultation in the emergency department on inpatient length of stay
J Palliat Med
A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT)
JAMA
Shared decision making to support the provision of palliative and end-of-life care in the emergency department: a consensus statement and research agenda
Acad Emerg Med
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Disclosures: The authors have nothing to disclose.