695 Quantifying emergency medical services encounters in patients receiving hospice and palliative medicine consults (Palliative Medicine Interest Group)
Recommended Citation
Gunaga S, Al-Hage A, Welchans M, Buchheister A, Corcoran J, Awada M, Smiles B, Weber J, Lakshmish Kumar BR, Swan K, Etu E, Miller J. 695 Quantifying emergency medical services encounters in patients receiving hospice and palliative medicine consults (Palliative Medicine Interest Group). Acad Emerg Med 2024; 31(S1):306-307.
Document Type
Conference Proceeding
Publication Date
5-13-2024
Publication Title
Acad Emerg Med
Abstract
Background and Objectives: Recent literature as well as a formal position statement by Emergency Medical Services (EMS) and Hospice and Palliative Medicine (HPM) leaders have placed a spotlight on the intersection between EMS and patients at the end of life. This study aims to quantitatively evaluate EMS prevalence and utilization patterns among adult patients requiring HPM consultations. Methods: We conducted a retrospective cohort study of electronic health records from five hospitals and nine emergency departments (ED) within a large metropolitan health system. The study period spanned from 1/1/2018 to 12/31/2022 and included data from all patients >18?years old who had HPM consults ordered during ED or inpatient encounters. Patient-specific data were collected including number and timing of EMS transports as well as final hospital disposition outcomes. The yearly and cumulative numbers of ED visits, EMS arrivals, and inpatient admissions were obtained to calculate prevalence statistics. Data analysis included summary counts and descriptive statistics. Results: Over the 5-year study period, a total of 33,262 HPM encounters were identified for 27,598 unique patients, with 5099 (15.3%) encounters resulting in in-hospital death. Of these HPM encounters, 55.2% (18,368) used EMS as their mode of initial hospital arrival, 4.7% (1549) for interfacility transport, and 44.2% (14,713) utilized EMS at hospital discharge. Notably, of discharged HPM EMS encounters (14,713), 53.7% (7906) were dispositioned to hospice facilities, 36.4% (5357) to skilled nursing facilities, 4.4% (651) to long-term care facilities, 2.7% (393) to rehabilitation facilities, and 1.8% (269) to short term hospitals. Overall HPM EMS utilization patterns demonstrated that 74.5% (24,766) of these encounters had at least one EMS interaction. More precisely 25.5% (8496) of HPM encounters had no EMS involvement, 44.1% (14,652) had one EMS interaction, 29.7% (9889) had two EMS interactions, and 0.7% (225) had three EMS interactions. Conclusion: Approximately 75% of hospitalized patients requiring HPM consultations will encounter EMS at least once, emphasizing a key space for primary palliative care. To optimize the quality of end of life care in this prehospital and interhospital window, ongoing efforts in prehospital primary palliative care education and HPM-specific EMS protocol development are essential.
Volume
31
Issue
S1
First Page
306
Last Page
307
