DescriptionPurpose of Project: The purpose of this project aimed to improve care management and quality of life for palliative care appropriate (PCA) patients through the early initiation of a palliative care referral in the Emergency Department (ED).
Methodology: This quality improvement project with post-intervention chart reviews included all ED providers and registered nurses (RNs) who participated in a 20-minute educational session about the use of an evidence-based screening tool called "Palliative Care and Rapid Emergency Screening Tool" (P-CaRES). P-CaRES was utilized for the identification of ED patients with significant unmet palliative care needs for four weeks. The chart review was performed post-intervention to determine the impact of the screening tool on care management for PCA patients.
Results: The data analysis consisted of 73 charts for PCA patients, 25 with a PC referral (Group A) and 48 without PC referral (Group B) ordered in the ED. There was a statistically significant decrease in the length of stay (LOS) for PCA patients in Group A (p < 0.001) and the number of consults ordered during admission (p < 0.001). Referrals made in the ED also showed a statistical significance in the discharge disposition of the PCA patients (p < 0.001) with 14 of 73 (Group A =1, Group B =13) readmitted in 30 days. There was no statistical significance in the use of intensive care unit (ICU) services (p = 0.284) and the LOS in the ICU (p = 0.122). Total PC referrals in the ED the month before implementation was 3 versus 25 during implementation.
Implications for Practice: Emergency Departments should incorporate a palliative care protocol, which includes formal educational sessions.