CAPC Palliative Care Discussion Forum
Palliative Care and Emergency Medicine
Dear all,
At Beth Israel Medical Center NYC,we are working on a brief screening tool in the ED to improve the recognition of unmet palliative care needs.
We would like to have your feedback on our tool and also to know if anywhere else some similar projects exist and could be shared.
Here is our Brief PC Screening Tool, it is supposed to be used by nurses.
Looking forward to hearing from you,
_________________________________
1) Does the patient have any of the following advanced life-limiting illnesses?
(check all that apply)
Severe dementia (unable to bathe, urinary incontinence, etc.) ____
Other severe CNS disease (e.g., stroke, with progressive decline) ____
Cancer (receiving palliative chemotherapy or radiation) ____
AIDS (CD4<200 or AIDS defining illness, progressive decline) ____
Congestive heart failure (with marked activity limitation) ____
Chronic obstructive pulmonary disease (requiring home O2) ____
Other advanced disease (pulmonary hypertension, CAD, other) ____
2) Has the patient had progressive losses of Activities of Daily Living and/or
a severe decline in functional status?
Yes _____ No ______
3) Does the patient demonstrate any of the following unmet palliative care needs? (Circle one or more)
Guidance with pain and/or non-pain symptom management Y N
Advance Care Planning/Advance Directives Y N
Guidance with decision-making Y N
Bereavement Issues Y N
Frequent hospitalization for advanced illness Y N
Spiritual/emotional needs Y N
Hospice evaluation/referral Y N
_________________________________
If “Yes” to Questions 1 – 3, do you feel that the patient/family would benefit from a palliative care consult?
Yes _____ No ______
If YES, a palliative care consultation should be discussed with the attending for the patient. If you and the attending agree that the patient has unmet palliative care needs, a call should be placed to the patient’s primary physician if available, to involve him/her in the decision. If the primary physician is unavailable, please consider the urgency of the patient’s unmet needs in your decision to consult palliative care.
If NO, or if you are unable to obtain a palliative care consult, please explain: ___________________________________________________________________________________________________
If you are requesting a non-urgent palliative care consultation during weekend and evening hours, please leave a message on the Palliative Care Consult Hotline at 212-844-1361. These messages are picked up daily and the patient will receive a palliative care consult within 24 hours.
If you are requesting a palliative care consult during the day, Monday-Friday or an urgent palliative care consult, please page the Palliative Care Fellow at beeper # 10908.
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BIMC ED Palliative Care Screening Tool
Very cool project! If you are looking for more examples of indicators that signal a need for a PC consult, there is a piece in the JPM that addresses PC in the ED, "Fast Response is Key to Partnering with the Emergency Department” Diane E. Meier, Larry Beresford, Journal of Palliative Medicine. 2007, 10(3): 641-645."
There was also an audio conference on this topic in 2007, you can purchase a recording by going to the eMarketplace, or you can download the PPT by going to:
http://www.capc.org/support-from-capc/audio-conf/past-audio-conf/january-11-2007-audio-conference/index_html
Best wishes, Kathleen Kerr, Senior Analyst, University of California San Francisco, Palliative Care Leadership Center
In addition to Kathleen Kerr's excellent response, I would also add a few comments.
I think this is a really nice screen for palliative care needs. My major comment would be to make sure that the tool meets the needs of the ED. You may have already collaborated with them to develop this, but if not, I recommend doing so.
The ED has a number of its own needs ("through-put" usually first among them). And buy-in from the ED for your service will be much better if the pc consult service mission is aligned with the mission of the ED.
For instance, questions like "Has this patient had multiple unnecessary visits to the ED" or "Would clarification of this patient's goals of care help with disposition of the patient out of the ED" might really catch the attention of the ED staff.
Would love to hear from ED staff or from others expanding their pc into the ED.
best,
mike rabow, MD
Associate Director, UCSF PCLC