Patients and clinicians can benefit from having palliative care consults available in hospital emergency departments, though currently few providers have done so.
Populations who most need palliative care are often chronically ill seniors with complex health conditions. Between 2014 and 2017, these patients accounted for more than 20% of all emergency department (ED) visits in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC).
Having palliative care clinicians on deck in the ED can ease burden on the department’s staff and help ensure that patients receive goal concordant care, according to a recent study published in the Journal of Palliative Medicine.
“This ED-embedded palliative care consultation service was clinically meaningful, operationally viable, and delivered a 6.7x ROI,” the authors found. “ED-palliative partnerships present a quadruple aim opportunity to improve care for seriously ill patients.”
For a 12-month period starting August 2020, researchers set up an embedded palliative care consultation service in a 350-bed urban community hospital that saw around 45,000 ED visits annually.
During the study period, one palliative care clinician was stationed in the ED between 11am and 7pm each day.
Consequently, the ED soon became the hospital’s primary sources of palliative care consults, which increased tenfold. Among the patients who received the consults, 49% had a changed code status; 11% were admitted to a lower level of care, and 11% avoided hospitalization. In addition, 17% received hospice referrals, and 21% were referred to a palliative care outpatient clinic.
The program also led to significant reductions in hospital lengths of stay, the study indicated, and staff perceptions of the initiative were very positive. The consults yielded $5,974 in median direct cost savings for index hospitalization, per patient.
Compared with consultations in the intensive care unit, those who had received them in the ED saw a 4.2-day reduction in their hospital stay, generating $9,332 in savings per patient.
A second study published this year evaluated clinicians’ experiences with having palliative consults in the ED, also published in the Journal of Palliative Medicine.
The study’s authors embedded palliative care clinicians in the ED of an urban, academic hospital and later surveyed 142 clinicians about their experiences.
“Quantitative analysis found that 99% of participants found the program valuable, the authors wrote. “Benefits of embedded PC included changing patients’ management or care trajectory, freeing up ED providers for other tasks, contributing to provider education, helping providers feel more supported during their shifts, and adding to providers’ skill sets and confidence in practicing primary PC.”