Identifying Palliative Care Needs in the Emergency Department: Better Care, Lower Cost

2006 ◽  
Vol 13 (5Supplement 1) ◽  
pp. S96-S96 ◽  
Author(s):  
J. B. Cassel
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Lower Cost ◽  
Care Needs ◽  
Palliative Care Needs

scholarly journals Palliative Care Needs of Advanced Cancer Patients in the Emergency Department (S767)

2018 ◽  
Vol 55 (2) ◽  
pp. 693
Author(s):  
Isabelle Marcelin ◽  
Caroline McNaughton ◽  
Nicole Tang ◽  
Jeffrey Caterino ◽  
Corita Grudzen
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients ◽  
Care Needs ◽  
Palliative Care Needs

scholarly journals Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs

2015 ◽  
Vol 22 (7) ◽  
pp. 823-837 ◽  
Author(s):  
Naomi George ◽  
Nina Barrett ◽  
Laura McPeake ◽  
Rebecca Goett ◽  
Kelsey Anderson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Screening Tool ◽  
Content Validation ◽  
Care Needs ◽  
Emergency Department Patients ◽  
Palliative Care Needs

“They Shouldn’t Be Coming to the ED, Should They?”: A Descriptive Service Evaluation of Why Patients With Palliative Care Needs Present to the Emergency Department

2017 ◽  
Vol 34 (10) ◽  
pp. 984-990 ◽  
Author(s):  
Emilie Green ◽  
Sarah Ward ◽  
Will Brierley ◽  
Ben Riley ◽  
Henna Sattar ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
A Priori ◽  
Service Evaluation ◽  
Palliative Care Team ◽  
Care Team ◽  
Care Needs ◽  
Direct Admission ◽  
Palliative Care Needs ◽  
Single Center Observational Study

Background: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. Methods: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period. Demographic and clinical data were collected from electronic health records. Results: A total of 105 patients made 112 presentations to the ED. The 2 most common presenting complaints were shortness of breath (35%) and pain (28%). Eighty-three percent of presentations required care in the ED according to a priori defined criteria. They either underwent urgent investigation or received immediate interventions that could not be delivered in another setting, were referred by a health-care professional, or were admitted. Conclusions: Findings challenge the misconception that patients known to a palliative care team should be cared for outside the ED. The importance and necessity of the ED for patients in their last years of life has been highlighted, specifically in terms of managing acute, unpredictable crises. Future service provision should not be based solely on a patient’s presenting complaint. Further qualitative research exploring patient perspective is required in order to explore the decision-making process that leads patients with palliative care needs to the ED.

Derivation and validation of a risk model for emergency department palliative care needs assessment using the Screen for Palliative and End-of-Life Care Needs in the Emergency Department (SPEED).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 22-22
Author(s):  
Danielle Moulia ◽  
Zachary O. Binney ◽  
Tammie E. Quest ◽  
Paul DeSandre ◽  
Sharon Vanairsdale ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Cancer Patients ◽  
Risk Model ◽  
Metastatic Cancer ◽  
Hospital Death ◽  
Care Needs ◽  
Temporal Validation ◽  
Speed Score ◽  
Palliative Care Needs

22 Background: A key setting for the provision of palliative care is the emergency department (ED) where important decisions regarding treatment and next site of care are determined; however identifying patients who would benefit from a palliative care consult is an ongoing challenge. The (SPEED) is a 5-question tool that assesses unmet palliative care needs. Methods: We performed a retrospective derivation and temporal validation of a risk model for a palliative care event (PCE) among cancer patients with an ED visit and subsequent hospital admission using data available upon arrival, including data from the SPEED tool. A PCE was defined as a palliative care consult, discharge to hospice, or in-hospital death. We developed a multivariate logistic regression model to predict PCEs. We assessed model performance using a receiver operating characteristic curve and visual inspection of quintile plots. Results: Eleven factors were identified as predictive of a PCE, including SPEED score, proxy SPEED informer, age, EMS arrival, emergent or immediate ED acuity, the number of ED visits within the last 90 days, metastatic cancer, cardiac arrhythmias, coagulopathy, depression and weight loss. In validation, the risk model had an area under the curve of 0.72 and calibration showed an underestimation of risk in the second and third quintiles. Conclusions: A risk model based on SPEED score has been successfully derived, but needs a larger dataset for proper validation. If the predictive ability of the model is confirmed, a risk model can efficiently identify cancer patients arriving to the ED who may benefit from early initiation of a palliative care consult.

Palliative Care and Rapid Emergency Screening Tool and the Palliative Performance Scale to Predict Survival of Older Adults Admitted to the Hospital From the Emergency Department

2020 ◽  
pp. 104990912096071
Author(s):  
Jonas R. Te Paske ◽  
Sarah DeWitt ◽  
Robin Hicks ◽  
Shana Semmens ◽  
Leigh Vaughan
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Palliative Care ◽  
South Carolina ◽  
Performance Status ◽  
Care Needs ◽  
Vital Status ◽  
Prognostic Utility ◽  
Palliative Care Needs ◽  
Performance Scale

Background: The Palliative Care and Rapid Emergency Screening (P-CaRES) tool has been validated to identify patients in the emergency department (ED) with unmet palliative care needs, but no prognostic data have been published. The Palliative Performance Scale (PPS) has been validated to predict survival based on performance status and separately has been shown to predict survival among adults admitted to the hospital from the ED. Objective: To concurrently validate the 6-month prognostic utility of P-CaRES with a replication of prior studies that demonstrated the prognostic utility of the PPS among adults admitted to the hospital from the ED. Design: Prospective cohort study. Setting/Subjects: Adults >55 years admitted to the hospital from the ED at an urban academic hospital in South Carolina. Measurement: Baseline PPS score and P-CaRES status were evaluated within 51 hours of admission. Vital status at 6 months was evaluated by phone or chart review. Results: 131 of 145 participants completed the study. Six-month survival was 79.2% of those with a PPS of 60-100 (22/106 died) and 48% of those with a PPS of 10-50 (13/25 died) (p = 0.0004). Six-month survival was 85.2% for P-CaRES negative (13/88 died) and 48.8% for P-CaRES positive (22/43 died) (p < 0.0001). The inferred hazard ratio (HR) for PPS 10-50, as compared to PPS 60-100 was 3.003 (95%CI (1.475, 6.112) p = 0.0024) and the HR for P-CaRES positive, as compared to P-CaRES negative was 4.186 (95%CI (2.052, 8.536) p < 0.0001). Conclusion: The P-CaRES tool and PPS can predict 6-month survival of older adults admitted from the ED.

scholarly journals P045: Palliative care nurse specialist in the emergency department: a pilot project

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S79
Author(s):  
K. Nichol ◽  
L. Galitzine ◽  
L. Kachuik ◽  
S. Madore ◽  
S. Olivier ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Palliative Care ◽  
Pilot Project ◽  
The United States ◽  
Nurse Specialist ◽  
Care Hospital ◽  
Care Needs ◽  
Care Nurse ◽  
Palliative Care Needs

Background: Patients presenting to the Emergency Department (ED) with unmet palliative care needs are often admitted to hospital and this can be a pivotal point in their subsequent health care journey. Literature from the United States supports the integration of palliative care resources in the ED and to our knowledge, this has yet to be done in a Canadian setting. Aim Statement: To develop, implement, and evaluate a model to support patients presenting to the ED with unmet palliative care needs. Measures &amp; Design: A pilot project was implemented in one campus of the ED at a tertiary care academic center in Ottawa, Ontario. A palliative care nurse specialist was available for consultation with goals to: a) reduce admission to hospital for patients choosing to have a palliative approach to their care; b) increase coordination between ED and community resources; and c) be a resource for ED staff. Referral criteria were developed after systematic review of the literature and in consultation with palliative and emergency medicine experts. Evaluation/Results: Over the course of the study period (9 months), 50 referrals were made. The primary reason for referral was for increased community supports. Patient outcomes: 10 patients were discharged to hospice/palliative care units from the ED, 38 patients were discharged home. Of those discharged home, 66% had no returns to ED within 30 days. Qualitative feedback collected via pre and post survey has been extremely supportive from ED health care practitioners and community palliative care providers. Discussion/Impact: This ongoing project has led to positive, patient centered outcomes and decreased admission to acute care hospital. Ongoing evaluation will include consideration of Ontario Palliative Care Network quality indicators and cost-analysis to determine impact on health care system.

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