Abstract
Background: Palliative care (PC) is essential to high quality management of patients with chronic illnesses, dementia, and functional decline; however, PC is underutilized. A potential time to initiate goals of care conversations is when patients are admitted from the emergency department (ED). At an academic medical center in the Midwest, there are currently zero PC consults initiated from the ED. |
Objectives: The purpose of this quality improvement project was to increase identification of persons who qualify for a palliative care consult when seen in a Level 1 ED of an academic medical center in the Midwest. |
Design: Education regarding the significance of an early PC consult and the Palliative Care and Rapid Emergency Screening (P-CaRES) tool was provided to Hospital Medicine Service (HMS) team and ED staff. ED nurses were to screen every patient 55 years or older admitted by the HMS team. If the patient qualified, the ED nurse informed HMS and a formal consult was to be made.|
Setting/Subjects: Project was completed in a Level 1 ED of a Midwest academic medical center. Patients 55 years or older admitted by HMS from the ED qualified for the study.|
Measurements: P-CaRES tools and electronic health record (EHR) were used for data collection and compliance tracking.|
Results: Out of 1,010 patients who met criteria, 30 patients were screened with P-CaRES tool, and three of those received a formal PC consult. Despite initial “buy-in” by HMS team and ED staff, screening of eligible patients was extremely low.|
Conclusions: Burnout from the COVID-19 pandemic, time constraints, screening tool fatigue, and new staff contributed to the low compliance with screening in this study. Although the ED is the potential place for PC consults, barriers will need to be overcome before routine screening is implemented.