An Integrated Model of Palliative Care in the Emergency Department to Improve Referrals

Introduction: The emergency department plays a critical role in the trajectory of in-hospital patient care. The Center to Advance Palliative Care (CAPC) along with the American College of Emergency Physicians (AECP) recommend early referral to palliative care for patients with life limiting illnesses that present to the emergency department. Research demonstrates that early palliative care consultations result in patient directed goals of care, improved symptom management, decreased length of stay, and reduced direct costs for inpatient hospitalizations. Objectives: The goal of this project was to implement evidence-based recommendations for early palliative care referrals in an adult emergency department to improve patient goals of care, augment symptom management, and decrease health care utilization. Methods: Retrospective chart reviews were completed to identify emergency department patients that met screening criteria for palliative care needs. Additionally, a tool-kit containing a validated two-step palliative care screening tool, marketing and educational materials for providers, and a sustainability plan was developed. Results: This project utilized a standardized tool-kit to help inform the organization on evidence-based recommendations. Retrospective data identified a gap in care between patients that screened positive for palliative care needs and patients that were consulted by palliative care. Conclusions: This project was expected to improve emergency department initiated palliative care referrals for patients with life limiting illness. Early referrals were predicted to improve patient goals of care, symptom management, and length of stay. The impact on health care utilization was expected to decrease and therefore reduce overall cost. Implications: Screening can identify patients who may benefit from a palliative care consultation. Early palliative care referrals allow patient directed goals of care, appropriate allocation of healthcare resources, and symptom management for patients with a life-limiting illness