Palliative Care in the ED

- Welcome to MicroED, quick facts for big issues. My name's Corita Grudzen, and I'm an emergency physician. Here are some tips about how to use palliative care in the ED. ED visits for older adults with serious life-limiting illness continue to grow. Many prefer to receive care at home and avoid life-sustaining therapies. Hospice and palliative medicine is a subspecialty that's been shown to decrease symptom burden, increase patient and family satisfaction, and improve quality of life. However, teams are limited in number, and they're consulted far too late. Primary palliative care is provided by generalists and can and should be delivered by emergency physicians. Assessing for advanced directives is vital to ensure care that's concordant with patients' previous wishes. Hospice care, usually delivered at home, focuses on relief of burdensome symptoms and caregiver support. Hospice patients may arrive in the ED for many reasons that deserve careful inquiry and communication with the hospice team. In the ED, primary palliative care includes assessing for the presence of advanced directives, inquiring about hospice and communicating directly with the agency, and aggressively treating burdensome symptoms. Specialty palliative care in the ED, usually in the form of consultation from an inpatient team, should be considered for unclear goals of care or family conflict, discharge planning for patients actively dying or whose goals are consistent with hospice care. Thank you for listening, and we hope this improves your practice.