In light of this, emergency medicine is increasingly incorporating palliative care (PC) into its service lines and educational programming. These efforts target the arms of the quadruple aim: better patient outcomes and reduced cost, as well as improved patient and provider experiences. Models delivering PC services in the emergency department run the gamut from fully integrated PC services led by the emergency department itself to strategic educational partnerships with existing palliative provider teams.
ACEP’s Palliative Care Section recently discussed these developments with Christian Sinclair, MD, assistant professor of palliative medicine at the University of Kansas in Kansas City, president of the American Academy of Hospice and Palliative Medicine (AAHPM), and editor of the website Pallimed.org.
Section: ACEP’s leadership recently initiated conversations with AAHPM about best practice guidelines for PC’s role in emergency medicine. Can you share any updates on these discussions?
CS: At AAHPM, we’re seeing there is a core skills set and knowledge base for providing PC in the ED. This is called “primary” or “generalist” palliative care. There are unique aspects in delivering PC in the ED that are different than an outpatient center or intensive care unit. Part of a strong approach to PC in the ED is understanding what the systems and delivery issues are. Then we need to figure out what core elements from PC are useful there. Any partnership needs to take into account the unique system aspects of the ED.
Section: Where do you see the ED evolving in the future as far as the continuum of care for palliative patients?
CS: There are a lot of EDs that have gotten good at saying, “We can have these tough conversations; we can change to goals of care that fit the patient’s preferences and get someone admitted to inpatient hospice without admitting them first to the hospital.” This is great.
However, there are a lot of patients who fall in the gap between not meeting criteria to be admitted to the hospital and not being safe for discharge home. These patients need sophisticated support, but they’re not ready for hospice.