Emergency-Department-Initiated Palliative Care Consults: A Descriptive Analysis

Abstract

EDI-PCC patients are young, likely secondary to traumatic and critical, sudden events. In-hospital mortality rate for EDI-PCC patients is very high (most die early and in the ED setting), signifying a trend for ED clinicians to request PC consults in those who are imminently dying. PC consult teams called to the ED should expect to provide high-priority, time-sensitive services and anticipate a high level of bereavement/emotional support for distraught and unprepared families, with major discussions around end-of-life care.

Understanding emergency department staff needs and perceptions in the provision of palliative care

“…In particular, many of our respondents, like those in previous ED studies, seemed to equate palliative care with end‐of‐life care. This might be expected as ED‐initiated palliative consultations often involve imminently dying patients …”

Palliative Care Provision in the Emergency Department: Barriers Reported by Emergency Physicians

“…20,22 An end-of-life trajectory in ED is often only able to be identified retrospectively. 16 Many ED physicians report increased stress or conflict when prognosis and end-of-life directives are unclear and most default to providing life prolonging care in such cases. 9 Not surprisingly, studies find that most ED-initiated palliative consultations involve imminently dying patients who often die in the ED or soon after.…”

Emergency department staff priorities for improving palliative care provision for older people: A qualitative study

“…(12)(13)(14)(15)(16) Subsequently, on-going debates over the exact role of emergency clinicians in palliative care delivery, coupled with resource limitations such as time and space, leave clinicians vulnerable and often without direction in the management of these patients. (10,12,17,18) To ensure palliative care is delivered effectively it is vital to understand the perspectives and experiences of the ED nursing and medical clinicians. Absence of their insight and involvement leaves quality improvement efforts open to errors and misunderstandings about clinicians' capacity, ability and concerns.…”