A simplified screening tool to identify seriously ill patients in the Emergency Department for referral to a palliative care team

Cotogni, Paolo; Evangelista, Andrea; Filippini, Claudia; Gili, Renata; Scarmozzino, Antonio; Ciccone, G; Brazzi, Luca

doi:10.23736/s0375-9393.16.11703-1

Cited by 13 publications

(20 citation statements)

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“…In accordance with the literature [ 11 , 12 , 13 , 14 , 15 ], we propose specific clinical indicators as potential criteria for considering each chronic disease as serious ( Table 2 ).…”

Section: Resultsmentioning

confidence: 92%

“…Recently, we have proposed the Simplified Screening Tool (SST) as an easy-to-use, non-disease-specific, and practical instrument to identify patients in the ED for referral to the PC team ( Figure 2 ). This tool could help physicians’ decision-making to appropriately match the healthcare services used with the patients’ needs in the clinical practice [ 15 ].…”

Section: Resultsmentioning

confidence: 99%

“…Firstly, it is extremely important to identify early (whether in the ED or within the first 24 hours after the hospital admission) the patients in need of PC among those with serious chronic diseases. In our study, we found that more than one-third of patients affected by these diseases awaiting to be hospitalized after an ED visit should be identified as in need of PC [ 15 ]. Secondly, the great challenge for healthcare professionals is to be prepared to manage the transition from curative care (‘active treatment’) to PC appropriately.…”

Section: Resultsmentioning

confidence: 99%

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Caring for Patients in Need of Palliative Care: Is This a Mission for Acute Care Hospitals? Key Questions for Healthcare Professionals

Cotogni

Luca

2022

Healthcare

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The prevalence of patients affected by end-stage diseases or advanced cancer is increasing due to an aging population and progression in medicine and public healthcare. The burden of symptoms these people suffer in the last months of life often forces them to seek aid in an emergency department. In developed countries, acute care hospital-based services are often better designed to treat acute clinical conditions than to manage the needs of patients with serious chronic diseases. Thus, the palliative care (PC) population poses very real clinical challenges to healthcare professionals who care for them in hospital settings. The authors have formulated four key questions (who, why, when, and how) to address in order to identify a model for providing the best care for these PC patients. The questions are related to: (1) defining people living with serious chronic diseases; (2) managing the challenge of unplanned hospital admission of these people; (3) identifying PC patients among people with serious chronic diseases; and (4) determining the appropriate work of caring for this inpatient PC population. Clinicians need the knowledge, tools, and services to care for these PC patients, and acute care hospitals should plan the work of caring for these inpatients.

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“…In accordance with the literature [ 11 , 12 , 13 , 14 , 15 ], we propose specific clinical indicators as potential criteria for considering each chronic disease as serious ( Table 2 ).…”

Section: Resultsmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Caring for Patients in Need of Palliative Care: Is This a Mission for Acute Care Hospitals? Key Questions for Healthcare Professionals

Cotogni

Luca

2022

Healthcare

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“…27 The proportion of patients with unmet PC needs who were hospitalized and received a PC consultation was reported to be 8%, 24 13%, 15 47%, 29 and 55% 19 across four studies. Patients with unmet PC needs who received a PC consultation postdischarge was reported to be 5%, 28 6%, 31 11%, 37,38…”

Section: Patients With Unmet Pc Needsmentioning

confidence: 99%

Screening tools to identify patients with unmet palliative care needs in the emergency department: A systematic review

Kirkland

Yang

Clua

et al. 2022

Academic Emergency Medicine

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Objectives This systematic review identified and assessed psychometric properties of the available screening tools to identify patients with unmet palliative care (PC) needs in the emergency department (ED). Methods A comprehensive search of electronic databases and the gray literature was conducted. Two independent reviewers completed study screening and inclusion, data extraction, and quality assessment. A descriptive summary of the results was reported using median of medians and interquartile ranges (IQRs). Results A total of 35 studies were included, involving the assessment of 14 unique screening tools. The most commonly used screening tool was the surprise question (SQ; n = 12 studies), followed by the Palliative Care and Rapid Emergency Screening (P‐CaRES) tool (n = 8), and the screening for palliative and end‐of‐life care needs in the emergency department (SPEED) instrument (n = 4). Twelve of the included studies reported on the psychometric properties of the screening tools, of which eight of these studies assessed the performance of the SQ to predict patient mortality. Overall, the median sensitivity (63%, IQR 38%–78%) and specificity (75%, IQR 57%–84%) of the SQ to predict mortality at 1 or 12 months was moderate. While the median positive predictive value of the SQ was low (32%, IQR 16%–40%), the median negative predictive value was high (91%, IQR 88%–95%). Across the studies, the proportion of patients identified as having unmet PC based on the criteria of the screening tools ranged from 5% to 83%. Conclusions This review identified 14 unique screening tools used to identify adult patients with unmet PC needs in the ED. One screening tool, the SQ, was found to have moderate sensitivity and specificity to accurately predict future patient mortality. Additional research is needed to better understand the clinical value of this and the other available tools prior to their widespread implementation.

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“…Similarly, the United Kingdom population has described an increase in more complex cases going to the ED, especially patients over 65 years with more than five underlying conditions, challenging management [2]. This increased volume of complex patients in the ED setting can lead to extended use of ED resources, increased hospital readmission rates, and a longer inpatient length of stay (LOS), putting patients at higher risk for hospital-acquired infections, delirium, and deconditioning [1,[3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Colectomy Complicated by High-Output Ileostomy Managed in a Virtual Hybrid Hospital-at-Home Program

Paulson

Maita

Ávila

et al. 2022

Case Reports in Surgery

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Chronically ill patients with superimposed acute illness requiring hospitalization are more likely to develop an extended length of stay, hospital-acquired infections, and adverse events throughout their hospitalization. An excellent alternative to managing this population of patients in the traditional bricks-and-mortal (BAM) hospital is the hospital-at-home (HaH) model. The Advanced Care at Home (ACH) program is Mayo Clinic’s HaH model that provides acute and postacute care to high-acuity patients in their homes rather than in the traditional hospital and skilled nursing facility. We report a case of postoperative care through the ACH program of a patient suffering from short gut syndrome, high-output ileostomy, and severe protein-calorie malnutrition in the setting of previously diagnosed triple-negative invasive ductal carcinoma (IDC) of the right breast complicated by lung and brain metastasis. The patient had multiple complications that required repeated scare escalations directed by a multidisciplinary virtual care. Despite these complications, the ACH model of care was able to keep the patient in the home setting the majority of the time, limiting BAM hospital days, and eliminating the need to use the emergency department for acute escalation for 3 months. The patient was able to recover during this time period and proceed to successful take-down of the ileostomy. This case highlights the benefits of the ACH program by offering high-acuity hospital-level care to severely ill patients in the comfort of their homes. Highly qualified providers paired with curated technology in the home allowed for prompt identification of patient decompensation and timely initiation of treatment while avoiding institutionalization.

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A simplified screening tool to identify seriously ill patients in the Emergency Department for referral to a palliative care team

Cited by 13 publications

References 0 publications

Caring for Patients in Need of Palliative Care: Is This a Mission for Acute Care Hospitals? Key Questions for Healthcare Professionals

Caring for Patients in Need of Palliative Care: Is This a Mission for Acute Care Hospitals? Key Questions for Healthcare Professionals

Screening tools to identify patients with unmet palliative care needs in the emergency department: A systematic review

Colectomy Complicated by High-Output Ileostomy Managed in a Virtual Hybrid Hospital-at-Home Program

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