A missed opportunity in the ED: Palliative care consult delays during inpatient admission

Study hypothesis: Although Emergency Medicine has recognized Palliative Care (PC) as an important aspect of Emergency Medicine, the importance of integrating palliative care into standard practice is underscored by the data that many patients qualify for PC but are not utilizing this part of medicine. We believe Emergency Medicine should integrate Palliative Care as our responsibility and not rely on our colleagues. To support our statement, we undertook an examination of patients who died while inpatient to identify whether they were appropriately receiving palliative care consults. We hypothesized that palliative care is under-utilized for patients during these admissions. Design, setting, and participant: Retrospective chart review from 2015 to 2018 of inpatient deaths using an Emergency Medicine Palliative Care Screening Tool to determine qualification for Palliative Care. Setting is John Hopkins Hospital. Participants were age 18 and over; who died during their inpatient admission. Main outcomes and measures: Percentage of patients who qualified for palliative care via the screening tool versus percentage of patients who had palliative care involvement. Results: The final study sample included 428 patients who died inpatient in the hospital between January 2015 and December 2018. The analysis used a Palliative Care Screening Tool to determine which patients would have qualified for palliative care. Analysis demonstrates that 66% of patients qualified for palliative care, whereas only 27% received it. Conclusion and relevance: The data reflects the percentage of patients who qualified for Palliative Care compared to the definite number of patients who received palliative care. The discrepancy in the percentages support our statement Emergency Medicine should take the lead on initiating palliative care for qualifying patients.