Abstract
1.Identify the PC needs of low-income emergency department (ED) patients with end-stage chronic illness.2.Determine the impact of ED-based palliative care consultation on ED utilization and hospital length of stay. Background. Palliative care (PC) improves quality of life of seriously ill patients through the prevention and relief of suffering. Little data exist examining the role of early PC intervention in the emergency department (ED). Research objectives. (1) Identify the PC needs of low-income ED patients with end-stage chronic illness. (2) Determine the impact of ED-based PC consultation on ED utilization and hospital length of stay. Methods. Prospective, randomized controlled trial using time randomization in a large public hospital ED, comparing ED-based PC consultation versus usual care. Patients included adults able to participate in informed consent, not on psychiatric hold. Baseline PC needs were explored with a comprehensive enrollment interview. Outcome measures included use of hospital inpatient and emergency services during subsequent year. Descriptive statistics, bivariate comparisons, and general linear models univariate and repeated measures analyses were conducted using SPSS. Results. Of 393 patients approached, 198 consented and were assigned to intervention (88) and control (110) groups; 51% males; average age 51.7 years; 62.4% had < 12 years education; 74.6% foreign born; 10.2% reported any employment. Participants reported high levels of pain (75% rated average ≥ 5 on 10-point scale) and depression (53.8% scored 3+ on PHQ-2) and poor overall quality of life (71.9% rated “fair”, “poor” or “very poor”). Just 15 (7.6%) reported having a durable power of attorney or living will. Of n =164 with known vital status, 54.3% died within one year. Based on intention-to-treat comparisons, there were no differences for survival or service use (adjusted for survival time) in the follow-up period. Aim. Understand the impact of palliative care consults in the ED on outcomes. Methods/session descriptions. Presentation of scientific study. Conclusion. Results suggest a need for PC consultation among vulnerable patients in ED. More complex analyses of health and social factors are needed to evaluate the effect of PC intervention on health system outcomes. Implications for research, policy, or practice. Little data exists on the integration of PC in the ED and how this impacts quality measures and outcomes. Structure and Processes of Care
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