Abstract
Purpose: The purpose of this evidence-based practice project was to implement and evaluate the use of a nurse-initiated palliative care screening tool in the emergency department (ED).|Background: ED visits for exacerbations of chronic conditions are on the rise (Powell, Ya, Isehunwa, & Chang, 2018). The utilization of palliative care services has been associated with a significant improvement in quality of life, decreased pain and anxiety, decreased healthcare costs, decreased hospital length of stay and readmissions, and increased patient and caregiver satisfaction (Center to Advance Palliative Care, n.d.; Fermia et al, 2016; George et al., 2015; Lamba et al., 2014; Wang, 2017; Wu, Newman, Lasher, & Brody, 2013). It is critical that ED care providers can identify patients who may benefit from palliative care services. |Sample/Setting: Seventy-two ED nurses in a large tertiary academic medical center participated in this project.|Methods: After completing an online educational module, nursing staff utilized the Palliative Care and Rapid Emergency Screening (P-CaRES) tool for patients presenting to the ED with unmet palliative care needs. Supportive care nurse consults were initiated for patients with positive screenings. An electronic medical record (EMR) review was conducted to compare the number and characteristics of pre- and post-intervention palliative and supportive care consults.|Results: In the three months prior to implementation of the P-CaRES screening, one supportive care nurse consult and 24 palliative care consults were initiated in the ED. Post-implementation, 99 supportive care nurse consults were initiated over a period of 98 days. Of these consults, 16 were escalated to a palliative care consult in the ED and 34 were escalated to a palliative care consult after admission to an inpatient unit.|Conclusion: The use of nurse-initiated screening with the P-CaRES tool produced a marked increase in palliative and supportive care consults in the ED.