Integrating Palliative Care Practices in the Emergency Department

Last Reviewed: March 4, 2019

Patients and families living with serious illness who are seen in the Emergency Department (ED) may receive palliative care services via either 1) referral for consult by the palliative care team, and/or 2) delivery of palliative care services by trained ED staff. Ideally, these models occur in parallel.

This toolkit was developed and curated by the Advisory Board of IPAL-EM: Improving Palliative Care in Emergency Medicine in an effort to increase access to palliative care services for patients in the ED and their families.

What’s in the Toolkit

The "what and why" of ED palliative care, including standards for ED palliative care and how to make the case.

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Making the Case for ED-Palliative Care Integration

Last Updated: February 3, 2019

Make the case to administrators for starting an ED-palliative care integration project. Includes data on gaps in 'usual' care and best practice recommendations.

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Clinical Practice Guidelines

Last Updated: February 25, 2019

THE IPAL-EM board has developed clinical practice guidelines for Emergency Department palliative care services, adapted from the National Consensus Project for Quality Palliative Care.

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Clinical Practice Guidelines: Self-Assessment

Last Updated: February 3, 2019

Used by emergency department and palliative care staff as a self-assessment tool to guide integration of palliative care services in the ED.

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Four Things to Do in a Week: Integrating Palliative Care Services into the Emergency Department

Last Updated: February 3, 2019

Kick-start an ED-palliative care integration project using a structured needs assessment.

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Getting Started: Organizing an ED Palliative Care Initiative

Last Updated: February 3, 2019

A roadmap for planning and implementing a project to integrate palliative care principles into daily emergency department care.

Practical guidance on model design and tools for identifying patients in the ED who would benefit from palliative care.

Advancing Palliative Care in the ED through Interdisciplinary Teamwork and the IPAL-EM Clinical Practice Guidelines

Last Updated: February 25, 2019

Webinar presentation.

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Getting Started: Keys to Success for an ED Palliative Care Initiative

Last Updated: February 3, 2019

Presenter: Tammie E. Quest, MD. March 2015.

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Palliative Care ED Screening Tool

Last Updated: February 3, 2019

Screening tool to identify patients with unmet palliative care needs. For ED staff.

The Effective and Efficient ED-Palliative Care Consult

Last Updated: February 25, 2019

Webinar presentation on palliative integration in the ED.

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Designing a Pediatric Palliative Care Program

Last Updated: March 4, 2019

See CAPC's toolkit guidance on pediatric palliative care delivery.

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Tools for both palliative care and ED teams to assess need, conduct family meetings about priorities for care, and provide services in the ED.

Primary Palliative Care Trigger Criteria

Last Updated: February 3, 2019

CAPC consensus report for identification of patients with palliative care need. 2011.

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Palliative Care ED Screening Tool

Last Updated: February 3, 2019

Screening tool to identify patients with unmet palliative care needs. For ED staff.

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Consultation Etiquette for Palliative Care in the Emergency Department

Last Updated: February 3, 2019

Key concepts for palliative care teams when providing consultations in the emergency department.

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Prescribing Opioids: A Pocket Reference

Last Updated: February 3, 2019

Opioid pocket reference for providers including safe starting doses, equianalgesic chart, and standard dosing strengths. Center to Advance Palliative Care, 2016.

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Clarifying Goals of Care: Key Takeaways

Last Updated: February 3, 2019

Stepwise approach that any clinician can use to improve conversations with patients about their goals of care. Center to Advance Palliative Care and Vital Talk, 2015.

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Family Conference Progress Note

Last Updated: February 3, 2019

For use by ED staff. Shared by Froedert Hospital, Medical College of Wisconsin.

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Family Conference Progress Note

Last Updated: February 3, 2019

For use by ED staff. Shared by Central Baptist Hospital.

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Family Witnessed Resuscitation Checklist

Last Updated: February 3, 2019

Sample tool used for quality improvement in the ED. Shared by Emory University Hospital Midtown.

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The Family Goal-Setting Conference

Last Updated: February 3, 2019

10-step guide including recommended phrases for the clinical team. Shared by Mount Sinai Hospital.

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Conducting a Family Meeting: Key Takeaways

Last Updated: January 29, 2019

Stepwise approach that any clinician can use to improve family meetings. Center to Advance Palliative Care and VitalTalk, 2015.

Measurement strategies to evaluate patient, family, and clinician satisfaction with services, in support of ongoing quality improvement.

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Evaluation of ED-Palliative Care Metrics & Quality

Last Updated: February 3, 2019

Consensus recommendations on key operational, clinical and satisfaction metrics that emergency departments can track to ensure quality palliative care services.

Measurement Best Practices

Last Updated: March 4, 2019

Use this toolkit to select program measures that demonstrate value to stakeholders and support quality care delivery. Overcome common measurement obstacles and synthesize program data.

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National Palliative Care Research Center (NPCRC) Measurement and Evaluation Tools

Last Updated: February 3, 2019

NPCRC provides measurement and evaluation tools for research, including pain and symptom management, functional status, psychosocial care, caregiver assessment, and quality of life.

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Train ED teams in communication skills and family caregiver support, including CAPC’s online CE curriculum on communication skills for clinicians from all disciplines.

Online Training Courses for All Clinicians

Last Updated: March 18, 2019

Online training curriculum for all specialties and disciplines to strengthen their care of patients living with serious illness. Free continuing education credits for all, and physicians receive ABIM MOC points for select courses.

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Education for Physicians on End-of-Life Care (EPEC)

Last Updated: February 3, 2019

Education in Palliative and End-of-life Care for Emergency Medicine (EPEC - Emergency Medicine) teaches essential clinical competencies in palliative care to professionals who work in the emergency department (ED).

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End-of-Life Nursing Education Consortium - Critical Care Train-the-Trainer Courses (ELNEC)

Last Updated: February 3, 2019

A train-the-trainer program, held once or twice annually at a specific location, covering eight curriculum modules. Participants receive up-to-date resources for teaching at their home institutions.

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Fast Facts and Concepts

Last Updated: January 29, 2019

Concise, practical, peer-reviewed and evidence-based summaries on topics important to clinicians and trainees caring for seriously ill patients. Use Fast Facts to onboard staff and for ongoing team education.

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Online information to explain the role and benefits of palliative care to patients and families.

Get Palliative Care

Last Updated: January 29, 2019

Information for patients and families about palliative care.

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End of Life: Helping with Comfort and Care

Last Updated: February 3, 2019

Jargon-free information for families of patients who are at the end of life. Published by the National Insitute on Aging (NIA).

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Talking to Children About Death

Last Updated: February 3, 2019

Guidance on discussing death with children in different age groups. Published by the National Institutes of Health.

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Hard Choices for Loving People

Last Updated: February 3, 2019

Information for patients and families facing decisions about CPR, artificial feeding tubes, living wills, ventilators, dialysis and other topics. The book is available for purchase and can also be downloaded free for personal use.

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Relevant publications for integrating palliative care in the Emergency Department.

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Reference Library

Last Updated: January 29, 2019

Relevant literature for palliative care-ED integration.

IPAL-EM

Last Updated: January 29, 2019

Members of CAPC's IPAL-EM Advisory Council, which co-authored many of the resources in this toolkit.

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Faculty

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