The Choosing Wisely campaign is making a big push to involve palliative care in the emergency department. Also, Michael J. Gerardi, MD, FAAP, FACEP, President of ACEP, has put palliative care in his strategic plan for this year, but why the ED?
We are caring for many patients with advanced chronic obstructive pulmonary disease, congestive heart failure, dementia, and other chronic conditions. More than 133 million Americans, or approximately 45 percent of the U.S. population, have at least one chronic disease.1,2 These chronic diseases are responsible for more than 1.7 million, or seven out of every 10, deaths in the United States.1–3 For the seriously ill, the ED is a staging area, which makes ED providers positioned to “screen and intervene.”4
Ideally, most conversations about a patient’s goals or prognosis wouldn’t happen in the ED, but they do. Often, the ED sees chronically ill patients declining without them understanding their waning medical situation or “having the talk” with their provider.5 This is likely due to a combination of factors: shrinking availability of primary care, lack of education and training by providers to discuss prognosis, and our silo system of medical subspecialties.5–10 In 2013, the US Department of Health and Human Services predicted the need to increase the number of primary care providers (PCPs) by 14 percent. However, the expected number of PCPs will only increase by 8 percent.11