Palliative Care Heads to the ED

By Haydn Bush	November 14, 2011
A new initiative aims to build up a growing trend toward offering palliative care services in hospital emergency departments.

Traditionally, palliative care has been thought of as an alternative to hospitalization for patients with terminal illnesses, allowing them to spend their final months and days in their homes with a modicum of comfort. But increasingly, hospitals are working to offer palliative techniques for terminally ill patients who show up in the emergency room, a phenomenon the Center to Advance Palliative Care hopes to support with an initiative launched last week, Improving Palliative Care in Emergency Medicine.

"The emergency department is an underappreciated but key site for patients and families to receive palliative care," Tammie E. Quest, M.D., director of the new initiative, said in a statement. "Seriously ill patients often experience pain and other symptoms that require immediate evaluation, excellent communication and 24/7 treatment."

While the release from the CAPC was short on specific action steps, it laid out some general parameters for the expected benefits of increased integration of palliative care in hospitals, including better control of symptoms, lower anxiety for patients' families and "more realistic" care plans better attuned to patients' personal preferences. For hospitals, the potential benefits listed include reducing length of stay and readmissions and potentially improving patient satisfaction.

"Every seriously ill hospitalized patient should have access to palliative care, and the emergency department is no exception," said Diane E. Meier, M.D., director of the Center to Advance Palliative Care in a statement. "We expect to see an enormous positive impact on both patients and their families."

I'll be watching these initiatives with both personal and professional interest. Years ago, I watched as my grandfather, after an initial admission for congestive heart failure, spent the last two weeks of his life subjected to a battery of increasingly complex and unsuccessful treatments and operations until he finally lost consciousness. Up until that point, he was mentally sound and in good shape, and it was painful to watch him suffer in his final days as his worsening physical and mental condition made it clear to all of us there would be no recovery. While he didn't need palliative care when he was initially admitted ? it wasn't until after a week in the hospital that he began spiraling downward ? at some point along the line it would have made more sense than the futile operations he had to endure in the final days of his life. And that's just the personal side of the story ? after decades of good health, a huge chunk of his lifetime medical bill was spent when he was beyond saving.

As it happens, I'm also writing an article on this topic for an upcoming edition of H&HN, and I'm interested in hearing your stories about how hospitals are embracing palliative care strategies. Email me at hbush@healthforum.com.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

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