Improved Outcomes and Cost with Palliative Care in the Emergency Department: Case-Control Study.

Area of Science:

• Medical Care
• Health Services Research
• Emergency Medicine

Background:

• Palliative care consultation teams offer significant benefits, including pain management and clinician satisfaction.
• Early palliative care initiation, particularly in emergency departments (ED), improves patient outcomes and can reduce hospital stays and costs.
• Hybrid physicians, dual-boarded in palliative and emergency medicine, present a novel approach to enhance care within the ED setting.

Purpose of the Study:

• To explore the impact of embedding hybrid physicians in the ED on patient outcomes and hospital resource utilization.
• To compare outcomes for patients seen by hybrid physicians in the ED versus those seen by traditional palliative care teams.

Main Methods:

• A pilot case-control study involving patients referred for palliative care within 24 hours of ED registration.
• Cases were patients seen by hybrid physicians embedded in the ED; controls were matched based on diagnosis, comorbidities, and referral date.
• Outcomes included hospital length of stay, total charges, discharge disposition, code status, and ED revisits; analyses used chi-square and Wilcoxon rank-sum tests.

Main Results:

• Hybrid physician cases had significantly shorter hospital stays (median 2.1 days) compared to controls (6.5 days, P<.001).
• Total charges were substantially lower for cases ($37,800) versus controls ($78,000, P<.001).
• 26.5% of ED visits for cases did not result in admission, unlike all controls (P<.001).

Conclusions:

• Embedding hybrid physicians in the ED significantly shortens hospital stays and reduces healthcare charges for critically ill patients.
• This model demonstrates potential for enhancing patient care and optimizing hospital resource allocation.
• Further research into integrating hybrid physicians in emergency departments is warranted.