Palliative Care Initiated in the Emergency Department: A Cluster Randomized Clinical Trial

Area of Science:

• Gerontology
• Palliative Care
• Emergency Medicine

Background:

• The emergency department (ED) presents a critical opportunity for initiating palliative care in older adults facing serious, life-limiting illnesses.
• Early palliative care interventions can significantly impact patient outcomes and healthcare utilization.

Purpose of the Study:

• To evaluate the effectiveness of a multicomponent intervention aimed at initiating palliative care within the ED.
• The study assessed the intervention's impact on hospital admission rates, subsequent healthcare utilization, and survival among older adults with serious illnesses.

Main Methods:

• A cluster randomized, stepped-wedge clinical trial was conducted across 29 US EDs involving patients aged 66 years or older with a high risk of short-term mortality.
• The intervention comprised multidisciplinary education, simulation-based communication workshops, clinical decision support, and audit and feedback for ED staff.
• Data from 98,922 ED visits were analyzed, comparing outcomes before and after intervention implementation.

Main Results:

• The intervention did not significantly alter the rate of hospital admission (64.4% pre-intervention vs. 61.3% post-intervention).
• No significant differences were observed in secondary outcomes, including intensive care unit admissions, ED revisits, hospice use, home health utilization, hospital readmissions, or 6-month mortality.
• Specific rates showed no statistically significant changes, with adjusted odds ratios generally approximating 1.0.

Conclusions:

• The tested multicomponent intervention did not demonstrate a significant effect on hospital admission, subsequent healthcare use, or short-term mortality in older adults with serious, life-limiting illnesses.
• Initiating palliative care in the ED through this specific intervention strategy did not yield the anticipated improvements in patient outcomes.
• Further investigation into alternative or refined strategies for delivering palliative care in emergency settings is warranted.