Arranging Hospice Care from the Emergency Department: A Single Center Retrospective Study

Rege, Rahul; Peyton, Kelee; Pajka, Sarah E; Grudzen, Corita; Conroy, Mary Carol; Southerland, Lauren T.

doi:10.1016/j.jpainsymman.2021.08.002

Cited by 4 publications

(3 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Third, for a subset of patients, serious illness interventions in the ED via an ED physician, nurse, social worker, or palliative care team member may change the trajectory of their care in the ED, especially in light of the accelerating ED boarding crisis . For example, hospice initiation from the ED can improve patient-centered outcomes while decreasing hospital resource use and length of stay . While the findings of a recent trial of an automated serious illness conversation suggest that serious illness interventions can narrow disparities among racially or ethnically minoritized patients, ongoing vigilance for bias in access, process completion, and impact will be needed to ensure health equity …”

Section: Discussionmentioning

confidence: 98%

“… 41 For example, hospice initiation from the ED can improve patient-centered outcomes while decreasing hospital resource use and length of stay. 42 While the findings of a recent trial of an automated serious illness conversation suggest that serious illness interventions can narrow disparities among racially or ethnically minoritized patients, 17 ongoing vigilance for bias in access, process completion, and impact will be needed to ensure health equity. 43 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Geriatric End-of-Life Screening Tool Prediction of 6-Month Mortality in Older Patients

Haimovich,

Burke,

Nathanson

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceEmergency department (ED) visits by older adults with life-limiting illnesses are a critical opportunity to establish patient care end-of-life preferences, but little is known about the optimal screening criteria for resource-constrained EDs.ObjectivesTo externally validate the Geriatric End-of-Life Screening Tool (GEST) in an independent population and compare it with commonly used serious illness diagnostic criteria.Design, Setting, and ParticipantsThis prognostic study assessed a cohort of patients aged 65 years and older who were treated in a tertiary care ED in Boston, Massachusetts, from 2017 to 2021. Patients arriving in cardiac arrest or who died within 1 day of ED arrival were excluded. Data analysis was performed from August 1, 2023, to March 27, 2024.ExposureGEST, a logistic regression algorithm that uses commonly available electronic health record (EHR) datapoints and was developed and validated across 9 EDs, was compared with serious illness diagnoses as documented in the EHR. Serious illnesses included stroke/transient ischemic attack, liver disease, cancer, lung disease, and age greater than 80 years, among others.Main Outcomes and MeasuresThe primary outcome was 6-month mortality following an ED encounter. Statistical analyses included area under the receiver operating characteristic curve, calibration analyses, Kaplan-Meier survival curves, and decision curves.ResultsThis external validation included 82 371 ED encounters by 40 505 unique individuals (mean [SD] age, 76.8 [8.4] years; 54.3% women, 13.8% 6-month mortality rate). GEST had an external validation area under the receiver operating characteristic curve of 0.79 (95% CI, 0.78-0.79) that was stable across years and demographic subgroups. Of included encounters, 53.4% had a serious illness, with a sensitivity of 77.4% (95% CI, 76.6%-78.2%) and specificity of 50.5% (95% CI, 50.1%-50.8%). Varying GEST cutoffs from 5% to 30% increased specificity (5%: 49.1% [95% CI, 48.7%-49.5%]; 30%: 92.2% [95% CI, 92.0%-92.4%]) at the cost of sensitivity (5%: 89.3% [95% CI, 88.8-89.9]; 30%: 36.2% [95% CI, 35.3-37.1]). In a decision curve analysis, GEST outperformed serious illness criteria across all tested thresholds. When comparing patients referred to intervention by GEST with serious illness criteria, GEST reclassified 45.1% of patients with serious illness as having low risk of mortality with an observed mortality rate 8.1% and 2.6% of patients without serious illness as having high mortality risk with an observed mortality rate of 34.3% for a total reclassification rate of 25.3%.Conclusions and RelevanceThe findings of this study suggest that both serious illness criteria and GEST identified older ED patients at risk for 6-month mortality, but GEST offered more useful screening characteristics. Future trials of serious illness interventions for high mortality risk in older adults may consider transitioning from diagnosis code criteria to GEST, an automatable EHR-based algorithm.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Geriatric End-of-Life Screening Tool Prediction of 6-Month Mortality in Older Patients

Haimovich,

Burke,

Nathanson

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…Finally, completing a same‐day transfer to inpatient or home hospice that circumvents an inpatient transition of care is favorable. Although many systems‐based barriers persist, including ED time constraints, timely access to care coordination, and the uneasiness of initiating an intimate goals‐of‐care conversation with a new patient, Quality‐driven programs that develop this infrastructure will ameliorate overall management of the oncology patient in the ED 211 …”

Section: End‐of‐life Care In the Edmentioning

confidence: 99%

Oncologic emergencies and urgencies: A comprehensive review

Rothberg

Quest

Yeung

et al. 2022

CA A Cancer J Clinicians

View full text Add to dashboard Cite

Patients with advanced cancer generate 4 million visits annually to emergency departments (EDs) and other dedicated, high‐acuity oncology urgent care centers. Because of both the increasing complexity of systemic treatments overall and the higher rates of active therapy in the geriatric population, many patients experiencing acute decompensations are frail and acutely ill. This article comprehensively reviews the spectrum of oncologic emergencies and urgencies typically encountered in acute care settings. Presentation, underlying etiology, and up‐to‐date clinical pathways are discussed. Criteria for either a safe discharge to home or a transition of care to the inpatient oncology hospitalist team are emphasized. This review extends beyond familiar conditions such as febrile neutropenia, hypercalcemia, tumor lysis syndrome, malignant spinal cord compression, mechanical bowel obstruction, and breakthrough pain crises to include a broader spectrum of topics encompassing the syndrome of inappropriate antidiuretic hormone secretion, venous thromboembolism and malignant effusions, as well as chemotherapy‐induced mucositis, cardiomyopathy, nausea, vomiting, and diarrhea. Emergent and urgent complications associated with targeted therapeutics, including small molecules, naked and drug‐conjugated monoclonal antibodies, as well as immune checkpoint inhibitors and chimeric antigen receptor T‐cells, are summarized. Finally, strategies for facilitating same‐day direct admission to hospice from the ED are discussed. This article not only can serve as a point‐of‐care reference for the ED physician but also can assist outpatient oncologists as well as inpatient hospitalists in coordinating care around the ED visit.

show abstract