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Palliative Care Screening Without Consultation: An Implementation Gap in Geriatric Emergency Department Palliative
Lindsey Yourman1,2, Nicholas Tom3, Jennifer Clay1,4
1UC San Diego Health, La Jolla, California, USA.
Context:
The Palliative Care and Rapid Emergency Screening (P-CaRES) tool identifies emergency department (ED) patients with unmet palliative care needs. Whether a documented positive screen changes consultation when no referral pathway is attached has not been reported.
Objectives:
To describe inpatient specialty palliative care consultation after P-CaRES screening in a geriatric ED where results generated no alert, order set, or referral.
Methods:
Retrospective cohort study of patients 65+ screened with P-CaRES from 2019 to 2024, comparing P-CaRES-positive and -negative patients; the primary outcome was inpatient specialty palliative care consultation.
Results:
Of 421 patients, 115 (27.3%) screened positive; they were older with longer hospitalizations. Consultation rates were nearly identical between positive and negative patients (13.9% vs. 13.7%, p = 1.00).
Conclusion:
P-CaRES identified older adults with serious illness but showed no meaningful difference in consultation (95% confidence interval [CI] excluded differences >8 points), indicating that a passively documented positive screen was not associated with specialty consultation.