Prevalence of palliative care patients in emergency departments

Köstenberger, Markus; Neuwersch, Stefan; Weixler, Dietmar; Pipam, W.; Zink, Michael; Likar, Rudolf

doi:10.1007/s00508-019-1530-5

Cited by 18 publications

(20 citation statements)

References 28 publications

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“…It potentially increases PC referrals, but it is not ideal to guide management and define priorities of care. A previous study14 revised all patients seeking the ED of a tertiary-care medical centre over 10 days. Patients were classified on arrival with the MTS and sequentially with the P-CaRES.…”

Section: Discussionmentioning

confidence: 99%

The palliative care triage system in advanced cancer emergency care: development and initial validation

Paiva

Seriaco

Oliveira

et al. 2022

BMJ Support Palliat Care

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ObjectiveWe aimed to develop and validate a new emergency triage tool for use on patients with cancer undergoing palliative care (PC).MethodsIn phase I, the new tool was developed after literature review and expert committee meetings. A prospective longitudinal study in phase II assessed the interobserver reliability of the tool. In phase III, a retrospective study of administrative data, the feasibility of routine use of the new tool and the associations with hospitalisation and survival times were evaluated.ResultsThe palliative care triage system (PCTS) was composed of check-list items and four colour-coded categories for maximum response time. In phase II, the PCTS was independently evaluated by two nurses for 102 attendances in the emergency department of the PC unit. An absolute agreement of 87.3% and a weighted kappa of 0.81 were observed. In phase III, all 493 attendances had the PCTS assessment registered in the medical records. The PCTS categories were associated with hospital admission (p<0.001) and survival times (p<0.001).ConclusionPCTS is a feasible tool to be used in routine ED triage of patients with advanced cancer undergoing PC. It is a valid instrument for predicting hospital admission rates and survival with high interobserver concordance rates.

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Section: Discussionmentioning

confidence: 99%

The palliative care triage system in advanced cancer emergency care: development and initial validation

Paiva

Seriaco

Oliveira

et al. 2022

BMJ Support Palliat Care

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“…While numerous studies have applied various screening tools to identify ED patients with unmet palliative care needs [ 10 , 14 – 20 ], an in-depth assessment of the potential differences in ED management between the patients identified as having or not having unmet palliative care needs is uncommon. Verhoeff et al [ 6 ] utilized the SQ to identify unmet palliative care needs among ED patients with advanced cancer, and found that patients with unmet needs presented with more symptoms, higher acuity, and died sooner than patients who were not positive for the SQ [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs

et al. 2021

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Introduction This study examined emergency department (ED) presentations of patients with end of life (EOL) conditions and patients having met and unmet palliative care needs were compared. Methods Presentations for EOL conditions were prospectively identified and screened for palliative care needs. Descriptive data were reported as proportions, means or medians. Bi-variable analysis for dichotomous and continuous variables were performed by chi-squared and T-tests (p≤0.01), respectively. A multivariable logistic regression model identified factors associated with having unmet palliative needs and reported adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results Overall, 663 presentations for EOL conditions were identified; 518 (78%) involved patients with unmet palliative care needs. Presentations by patients with unmet palliative needs were more likely to involve consultations (80% vs. 67%, p = 0.001) and result in hospitalization (69% vs. 51%, p<0.001) compared to patients whose palliative needs were met. Patients with unmet palliative care needs were more likely to have previous ED visits (73% unmet vs. 48% met; p<0.001). While medication, procedures, investigations and imaging ordering were high across all patients with EOL conditions, there were no significant differences between the groups. Consultations with palliative specialists in the ED (6% unmet vs. 1% met) and following discharge (29% unmet vs. 18% met) were similarly uncommon. Patients having two or more EOL conditions (aOR = 2.41; 95% CI: 1.16, 5.00), requiring hospitalization (aOR = 1.93; 95% CI: 1.30, 2.87), and dying during the ED visit (aOR = 2.15; 95% CI: 1.02, 4.53) were strongly associated with having unmet palliative care needs. Conclusions Most ED presentations for EOL conditions were made by patients with unmet palliative care needs, who were significantly more likely to require consultation, hospitalization, and to die. Referrals to palliative care services during and after the ED visit were infrequent, indicating important opportunities to promote these services.

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“…The first domain related to establishing the need for PC in EDs, with a significant focus on characterizing the patients that present to EDs with unmet PC needs 3,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] and qualitative studies examining the barriers and facilitators of doing this work in an ED setting. [40][41][42][43][44][45][46] The perspectives of ED clinicians and administrators has been systematically explored with a focus on barriers to care delivery, 41,42,[47][48][49][50][51][52] along with a body of work focused on editorials and calls to action.…”

Section: Gaps In the Literature To Datementioning

confidence: 99%

Mapping the future for research in emergency medicine palliative care: A research roadmap

Aaronson

Wright

Ritchie

et al. 2022

Academic Emergency Medicine

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Background The intersection of emergency medicine (EM) and palliative care (PC) has been recognized as an essential area of focus, with evidence suggesting that increased integration improves outcomes. This has resulted in increased research in EM PC. No current framework exists to help guide investigation and innovation. Objective The objective was to convene a working group to develop a roadmap that would help provide focus and prioritization for future research. Methods Participants were identified based on clinical, operation, policy, and research expertise in both EM and PC and spanned physician, nursing, social work, and patient perspectives. The research roadmap setting process consisted of three distinct phases that were time staggered over 12 months and facilitated through three live video convenings, asynchronous input via an online document, and a series of smaller video convenings of work groups focused on specific topics. Results Gaps in the literature were identified and informed the four key areas for future research. Consensus was reached on these domains and the associated research questions in each domain to help guide future study. The key domains included work focused on the value imperative for PC in the emergency setting, models of care delivery, disparities, and measurement of impact and efficacy. Additionally, the group identified key methodological considerations for doing work at the intersection of EM and PC. Conclusions There are several key domains and associated questions that can help guide future research in ED PC. Focus on these areas, and answering these questions, offers the potential to improve the emergency care of patients with PC needs.

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Prevalence of palliative care patients in emergency departments

Cited by 18 publications

References 28 publications

The palliative care triage system in advanced cancer emergency care: development and initial validation

The palliative care triage system in advanced cancer emergency care: development and initial validation

Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs

Mapping the future for research in emergency medicine palliative care: A research roadmap

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