The presence of an embedded palliative care practitioner in the emergency department can significantly improve patient outcomes and reduce costs.

A pilot program at the Michigan-based Corewell Health system in which a palliative physician was embedded in the ED effectively reduced inpatient mortality, readmissions, intensive care unit utilization and the total cost of care, while also boosting staff satisfaction, Lisa VanderWel, senior director for Corewell Health Hospice and Palliative Care, said during a presentation at the National Hospice and Palliative Care Organization (NHPCO) Annual Leadership Conference in Denver.

These results make sense when you consider the skill sets and outcomes associated with palliative care in the hospital and other settings, according to VanderWel.

“When you do really good palliative care, what happens?” she said during the presentation. “You have those [goals-of-care] conversations in a more timely manner. You have an earlier conversion to hospice. You avoid all the stress and crisis that’s involved if you wait until the last minute.”

Health systems can realize a 6.7% return on investment by embedding palliative care clinicians in the ED, a 2023 study published in the Journal of Palliative Medicine found. The researchers, from San Diego-based Scripps Health, also found that palliative consults increased 10x in the ED, contributing to increased hospice and palliative care clinic referrals.

A second study, done at Rush University Medical Center in Chicago, found that an embedded palliative practitioner increased consults by 591% over the course of one year, resulting in a more than 50% reduction in median hospital lengths of stay.

Data like these helped the palliative care teams at Corewell Health get the attention of executive decision makers as they sought to begin their own pilot program in the ED of Corewell’s Butterworth Hospital in Grand Rapids, Michigan.

Patients presenting at the emergency department is a crucial moment in their care trajectory, according to Dr. Jonathan Abraham, a board-certified palliative medicine and emergency medicine physician at Corewell Health. Abraham was embedded in a Corewell hospital’s ED during a pilot program.

“The emergency department is the entryway to the health care system for virtually all patients. It is a place where critical decisions are made that can totally alter the trajectory of care plans that impact patients and providers in myriad ways,” Abraham said in the NHPCO presentation. “All comers to the emergency department, three quarters of them, are presenting with pain or other bothersome symptoms. It’s also an environment that predominantly serves vulnerable populations and underrepresented minorities.”

Prior to the pilot’s launch, Corewell convened an Excellent at the End of Life Committee designed to improve outcomes for patients with serious or terminal illnesses. The committee included representation from Corewell’s palliative care; quality, safety and environment; care management; emergency department teams and other stakeholders.

Among the initiatives that this group pursued was the design of the ED embed pilot, including a “blitz” of education on hospice and palliative care among ED and other hospital staff and the development of associated workflows, according to VanderWel.

Those workflows focused on three areas: hospice patients who come to the ED, seriously ill patients with multiple comorbidities and those who had experienced a catastrophic event and were likely to die within one or two days.

Corewell embedded a palliative care physician in the emergency department as a full-time consultant Monday through Friday between 10am. and 6pm, which corresponded with most of the ED’s highest volume hours.

“The ED knows what palliative care is. They can recognize the need, but they’re strapped. They don’t have the resources or the bandwidth to dive into real, good goals-of-care conversations, and they feel badly about it,” Abraham said. “So having someone on hand to dive in and to help sort of lift up the team, lift up the patient, their family, is invaluable.”