365 Trends in Hospice and Palliative Medicine Consults Initiated in the Emergency Department: A Seven-Year Utilization Analysis

Document Type

Conference Proceeding

Publication Date

10-2-2023

Publication Title

Ann Emerg Med

Abstract

Objectives: Emergency departments (EDs) play a central role in end-of-life care, yet early integration of high-quality palliative care and hospice services is often under-utilized. Studies have shown that early access to these services improves patient outcomes, goal-concordant care and reduces health care costs. Translation of this evidence into clinical practice remains inconsistent, and the extent to which these services are utilized remains unclear. This retrospective cross-sectional cohort study aimed to describe the clinical prevalence and trends of ED ordered hospice and palliative medicine consults over a seven-year period in a large metropolitan health system. Methods: We conducted a retrospective cohort study of electronic health records (EHR) from five EDs within a large, integrated urban and suburban health system. The study period spanned from January 1st, 2016, to December 31st, 2022, and included data from all ED visits by patients > 18 years old who had a hospice and/or palliative medicine consult ordered in the ED. A variety of patient specific demographic, clinical, and outcome variables were collected. The yearly number of hospice and palliative medicine consults ordered in each ED were also obtained and compared by year and by site. Across years, we compared incident rates of hospice and palliative consults per 1,000 ED patients who were over 50 years old, had an ESI ≤ 3, and were admitted. Data analysis included descriptive statistics, chi-square testing, and regression analysis to examine trends over time. Results: A total of 6,097 hospice and palliative medicine consults were ordered in the ED for 5,687 ED encounters, and 5,345 unique patients meeting the inclusion criteria. The mean age of participants was 77.9 years ±13.7, with 57.2% being female and 74.7% identifying as White. Of the total cohort, 90.6% (5,152) were admitted to the hospital, 7.2% (410) were discharged home, 2.0% (112) died in the ED, and 55.2% (2,843) died during their hospital stay. Hospice and palliative medicine consults initiated in the ED showed a significant annual increase from 324 in 2016 to 1,328 in 2022, representing a 410% overall increase (p < 0.001). This seven-year trend is detailed in Figure 1. ED-ordered hospice consults outnumbered palliative consults 1.68 to 1 in 2016; however, in 2022 that ratio flipped to where ED palliative consults were 1.66 times more common. After the onset of the COVID-19 pandemic, there was a significant 188% increase in daily ED hospice and palliative consults when compared to pre-pandemic levels (p < 0.001). The calculated prevalence of hospice and palliative medicine consults in the ED for patients who were over 50 years old, had an ESI ≤ 3, and were admitted was 5.9 consults for every 1,000 visits (0.59%) in 2016. This prevalence significantly increased to 19.7 consults (1.97%) for every 1,000 visits in 2022 (p < 0.001). Conclusions: This study reveals an increasing trend of ED initiated hospice and palliative consults in our health system. Though promising, this effort likely only touches the surface of the unmet palliative needs of our ED patients and families. Further research is required to examine if these trends are observed across other healthcare facilities nationwide and to identify potential obstacles to implementation. [Formula presented] No, authors do not have interests to disclose

PubMed ID

Not assigned

Volume

82

Issue

1097-6760, 0196-0644

First Page

S161

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