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Evaluation of an Emergency Department-based Palliative Care Extender Program on Hospital and Patient Outcomes

Kalpana Narayan Shankar1, Julianne Dugas2, Sorraya Jaiprasert3

  • 1Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts.

The Western Journal of Emergency Medicine
|June 6, 2023
PubMed

Insights

Early palliative care in the emergency department (ED) reduced intensive care unit (ICU) admissions and length of stay for critically ill COVID-19 patients. This approach improved patient outcomes and resource use.

Area of Science:

  • Medical Research
  • Palliative Care
  • Health Services Research

Background:

  • Boston Medical Center, a safety-net hospital, observed high morbidity and mortality in COVID-19 patients due to health disparities.
  • A palliative care extender program was implemented to support critically ill emergency department (ED) patients during the crisis.
  • The study aimed to compare outcomes of palliative care initiated in the ED versus inpatient settings.

Purpose of the Study:

  • To evaluate the impact of early palliative care consultation in the emergency department (ED) on patient outcomes.
  • To compare resource utilization for patients receiving palliative care in the ED versus those receiving it as inpatients or in the intensive care unit (ICU).

Main Methods:

  • A matched retrospective cohort study design was employed.
  • Outcomes were compared between patients receiving palliative care in the ED and those receiving it as inpatients.

Main Results:

  • 82 patients received palliative care in the ED, and 317 received it as inpatients.
  • ED palliative care patients were less likely to experience a change in care level or ICU admission (P<0.001).
  • Average length of stay was significantly shorter for ED palliative care patients (5.2 days) compared to inpatient palliative care patients (9.9 days) (P<0.001).

Conclusions:

  • Initiating palliative care discussions in a busy ED is feasible and beneficial.
  • Early palliative care consultation by specialists in the ED improves patient and family outcomes.
  • This approach enhances resource utilization within the hospital system.
Abstract

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