Description

Purpose: To help Emergency Department staff identify end stage patients for whom direct admission to hospice or a comfort care only is most appropriate.
Design: Utilizing Evidence Based Practice it was determined that some patients are admitted from the Emergency Department to the acute care hospital with known terminal diagnosis.

Setting: This was implemented in an 88-bed inner city Level 1 trauma center and teaching facility which sees over 100,000 patients a year in its Emergency Department
Participants: Participants in this project consisted of Emergency Department Nurses, Physicians, Social Workers, Care Coordination, and Chaplain.

Methods: By utilizing a trigger tool developed by the Inpatient Palliative Care Team, Emergency Department Staff are able to proactively identify patients in the Emergency Department who would benefit from a palliative plan of care.

Results: Hospice referrals and advanced care planning in the Emergency Department with a decrease in inpatient admissions has been noted. Patients needing palliative and or end of life care can be identified earlier.

Implications: Patients often experience a delay in receiving comfort care because they are admitted to the hospital rather than hospice. These patients are counted as a hospital mortality when they die, even if they die enrolled in hospice.