Achieving Goal-Concordant Care With Goals of Care Consultations in the Emergency Department

Area of Science:

• Geriatric Medicine
• Healthcare Management
• Palliative Care

Background:

• Goals of Care (GOC) discussions are crucial for aligning medical care with patient preferences.
• Time constraints in urgent settings can delay critical GOC discussions, potentially misaligning care plans.
• Early GOC discussions may optimize patient outcomes and resource utilization.

Purpose of the Study:

• To evaluate the impact of early Advanced Illness Management (AIM) nursing GOC consultations on length of stay (LOS), intensive care unit (ICU) utilization, and direct costs of care.
• To determine if initiating GOC discussions upon admission improves patient care alignment and resource management.

Main Methods:

• Retrospective record review of patients aged 65 and older admitted to a community hospital between January and December 2023.
• Inclusion criteria required at least one documented GOC discussion with the AIM nursing team.
• Comparison between early AIM consultations initiated in the Emergency Department (ED) versus later consultations initiated after 24 hours (IP).

Main Results:

• Early AIM initiation in the ED (AIM ED) resulted in a significantly shorter median LOS (3 days) compared to later initiation (AIM IP = 6 days; P < 0.001).
• Median ICU hours were significantly lower for the AIM ED group (18.5 hours) versus the AIM IP group (40 hours; P < 0.001).
• Median direct costs of care were substantially less for the AIM ED group ($8470) compared to the AIM IP group ($15,406; P < 0.0001).

Conclusions:

• Forward-placement of GOC discussions by the AIM team within 24 hours of ED presentation yields significant benefits.
• Early GOC consultations are associated with reduced LOS, decreased ICU utilization, and lower direct care costs.
• These findings support the integration of early AIM GOC discussions into hospital admission protocols.