However, the average length of hospital stay for screened patients before and after intervention was largely unaffected, and results suggested that the program would not be financially sustainable using a social worker.
Also, about 70% of emergency physicians surveyed at the end of the program identified the social worker as the best professional to implement palliative care interventions in the ED. “So we provided a service, yet we freed our emergency physicians and emergency nurses from thinking about this, which is an unintended negative consequence of this study,” Dr. Todd commented.
A second project, undertaken in 2009-2010 and called the Emergency Department Palliative Care Champions (EDPCC) Pilot Project, involved outreach from his center to three New York City–area hospitals.
The center served as an external resource that fostered ED palliative care initiatives by supporting ED palliative care champions who disseminated education and conducted rapid quality-improvement projects in their departments.
Across the three hospitals – St. Vincent’s Medical Center, Mount Sinai Medical Center, and Kings Highway Division – the project ultimately involved 20 ED champions and 236 ED staff members, at a total program cost of about $125,500.
St. Vincent’s undertook nurse-initiated screening for unmet palliative care needs, training more than 40 nurse screeners and screening 22 patients in a 6-month period, according to Dr. Todd.
Mount Sinai conducted a quality audit of care for imminently dying patients, interviewing staff after patients died to determine what could have been done differently. This led to procedural changes in the ED, such as designating a space for grieving families.
Finally, Kings Highway Division undertook an initiative to improve implementation of advance directives. As a result, the proportion of patients for whom advance directive status was obtained increased from essentially zero to nearly 100%.
Overall, the EDPCC project has proven feasible and acceptable, and has potential for replication and dissemination, Dr. Todd contended. If funding is obtained, it will be expanded to the entire city.
He noted that emergency physicians are likely to have increasing access to palliative care specialists, as the percentage of larger hospitals having palliative care programs has increased to roughly 40%.
“This whole area of working hand in hand with our palliative care colleagues is one that I would like to encourage,” he concluded.