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Emergency Physicians Should Provide Palliative Care Options

By Rebecca Goett, MD, Marny Fetzer, MD, Kate Aberger, MD, FACEP, and Mark Rosenberg, DO, MBA, FACEP | on June 15, 2015 | 0 Comment
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Emergency Physicians Should Provide Palliative Care Options
ILLUSTRATION/PAUL JUESTRICH; PHOTOs shutterstock.com

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?

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Explore This Issue
ACEP Now: Vol 34 – No 06 – June 2015

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

Definitions

Palliative Care: Patient-centered care for any patient with a serious or chronic life-limiting illness, which can ideally be implemented for years. Palliative care aims to improve patients’ quality of life by providing pain and symptom relief and spiritual and psychosocial support. Integration of palliative care should be by patients’ regular providers or by dedicated palliative care providers who work alongside patients’ regular providers.17,18 Palliative care has been proved to improve quality of life, reduce hospital length of stay and number of repeat ED visits, improve patient and family satisfaction, lessen utilization of intensive care units, and provide overall cost savings to hospitals.6,18–20

Hospice: A type of health care for patients in the last months of their life when curative treatments are either not available or no longer wanted by patients. Hospice enrollment enables patients with a terminal diagnosis to receive comprehensive medical care outside the hospital, including nursing visits, medications, equipment, social work, and spiritual support.17,18 Although palliative care can overlap with hospice and the two are often lumped together, palliative care and hospice are not the same.

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

Pages: 1 2 3 | Single Page

Topics: ACEPAmerican College of Emergency PhysiciansChoosing WiselyEmergency DepartmentEmergency MedicineEmergency PhysicianPain and Palliative CarePractice Trends

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