RUcore: Rutgers University Community Repository
Implementing a palliative care screening tool in the emergency department
Descriptive
TitleInfo
Title
Implementing a palliative care screening tool in the emergency department
Name
(type = personal)
NamePart
(type = family)
Ciani
NamePart
(type = given)
Amanda
DisplayForm
Amanda Ciani
Role
RoleTerm
(authority = RULIB)
author
Name
(type = personal)
NamePart
(type = family)
Kameinski
NamePart
(type = given)
Mary
DisplayForm
Mary Kameinski
Affiliation
Advisory Committee
Role
RoleTerm
(authority = RULIB)
chair
Name
(type = personal)
NamePart
(type = family)
Clyne
NamePart
(type = given)
Timothy
DisplayForm
Timothy Clyne
Affiliation
Advisory Committee
Role
RoleTerm
(authority = local)
member
Name
(type = personal)
NamePart
(type = family)
Cruz
NamePart
(type = given)
Geraldine
DisplayForm
Geraldine Cruz
Affiliation
Advisory Committee
Role
RoleTerm
(authority = local)
member
Name
(type = corporate)
NamePart
Rutgers University
Role
RoleTerm
(authority = RULIB)
degree grantor
Name
(type = corporate)
NamePart
RBHS School of Nursing
Role
RoleTerm
(authority = RULIB)
school
TypeOfResource
Text
Genre
(authority = marcgt)
theses
OriginInfo
DateCreated
(encoding = w3cdtf);
(qualifier = exact);
(keyDate = yes)
2023
DateOther
(encoding = w3cdtf);
(type = degree);
(qualifier = exact)
2023-01
Language
LanguageTerm
(authority = ISO 639-3:2007);
(type = text)
English
Abstract
(type = abstract)
Purpose: Palliative care (PC) is a service that is often underutilized for patients with advanced chronic illnesses. Currently there is no specific policy for referrals for PC from the emergency department (ED). By implementing a screening tool for PC in the ED, these patients can be identified and referred. Implementation of an evidence-based PC screening tool will improve identification and referral of services to these patients. The purpose of this quality improvement project is to accurately screen for patients in the ED who may benefit from PC services.
Methodology: The P-CaRES screening tool was implemented in a 46- bed ED in an urban area of central New Jersey. All ED providers were educated on use of the screening tool. Patients over the age of 65 that were admitted to the ED were screened for unmet PC needs using the P-CaRES screening tool. Chart reviews were conducted to determine if screening, referrals, and consults for PC were affected by the implementation of the P-CaRES screening tool in the ED.
Results: In total 1208 patients over the age of 65 were seen in the ED over a two- month period and 33.4% were screened using the P-CaRES screening tool. During this time 22.1% screened positive for unmet PC needs and 27% of those screening positive were admitted to the hospital. Referrals for PC consultation were made for 92.3% of patients admitted to the hospital that screened positive for unmet PC needs. A total of 7.4% of patients admitted to the ED during the two-month period received a PC consult. A chi-squared statistical test for analysis was run to compare referral and consultation rates in the pre and post implementation periods. Results of the chi-squared test for referral rates showed a p value of 0.004 concluding there is a statistically significant difference in referral rates before and after the implementation of the P-CaRES screening tool with an increase in referrals after implementation. The chi- squared test for consult rates showed a p value of 0.592 concluding there was not a statistically significant difference in consultations before and after implementation.
Implications for Practice: Screening for PC in the ED can increase referral rates for PC in a timely manner. Screening patients for PC in the ED can reduce symptoms, improve outcomes for patients and their families, improve quality of life and decrease resource utilization.
Methodology: The P-CaRES screening tool was implemented in a 46- bed ED in an urban area of central New Jersey. All ED providers were educated on use of the screening tool. Patients over the age of 65 that were admitted to the ED were screened for unmet PC needs using the P-CaRES screening tool. Chart reviews were conducted to determine if screening, referrals, and consults for PC were affected by the implementation of the P-CaRES screening tool in the ED.
Results: In total 1208 patients over the age of 65 were seen in the ED over a two- month period and 33.4% were screened using the P-CaRES screening tool. During this time 22.1% screened positive for unmet PC needs and 27% of those screening positive were admitted to the hospital. Referrals for PC consultation were made for 92.3% of patients admitted to the hospital that screened positive for unmet PC needs. A total of 7.4% of patients admitted to the ED during the two-month period received a PC consult. A chi-squared statistical test for analysis was run to compare referral and consultation rates in the pre and post implementation periods. Results of the chi-squared test for referral rates showed a p value of 0.004 concluding there is a statistically significant difference in referral rates before and after the implementation of the P-CaRES screening tool with an increase in referrals after implementation. The chi- squared test for consult rates showed a p value of 0.592 concluding there was not a statistically significant difference in consultations before and after implementation.
Implications for Practice: Screening for PC in the ED can increase referral rates for PC in a timely manner. Screening patients for PC in the ED can reduce symptoms, improve outcomes for patients and their families, improve quality of life and decrease resource utilization.
Subject
(authority = RUETD)
Topic
Nursing
Subject
(authority = local)
Topic
Emergency medicine
Subject
(authority = local)
Topic
Palliative care
Subject
(authority = local)
Topic
Screening tool
RelatedItem
(type = host)
TitleInfo
Title
Rutgers University Electronic Theses and Dissertations
Identifier
(type = RULIB)
ETD
Identifier
http://dissertations.umi.com/RBHS:10194
PhysicalDescription
InternetMediaType
application/pdf
InternetMediaType
text/xml
Extent
67 pages : illustrations
Note
(type = degree)
D.N.P.
Note
(type = bibliography)
Includes bibliographical references
RelatedItem
(type = host)
TitleInfo
Title
School of Nursing (RBHS) DNP Projects
Identifier
(type = local)
rucore10004500001
Location
PhysicalLocation
(authority = marcorg);
(displayLabel = Rutgers, The State University of New Jersey)
NjNbRU
Identifier
(type = doi)
doi:10.7282/t3-d1er-fd09
Back to the top
Rights
RightsDeclaration
(ID = rulibRdec0006)
The author owns the copyright to this work.
RightsHolder
(type = personal)
Name
FamilyName
Ciani
GivenName
Amanda
MiddleName
Joy
Role
Copyright holder
RightsEvent
Type
Permission or license
DateTime
(encoding = w3cdtf);
(qualifier = exact);
(point = start)
2023-03-20T11:29:48
AssociatedEntity
Name
Amanda Joy Ciani
Role
Copyright holder
Affiliation
Rutgers University. RBHS School of Nursing
AssociatedObject
Type
License
Name
Author Agreement License
Detail
I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
RightsEvent
DateTime
(encoding = w3cdtf);
(qualifier = exact);
(point = start)
2023-03-20
DateTime
(encoding = w3cdtf);
(qualifier = exact);
(point = end)
2025-03-17
Type
Embargo
Detail
Access to this PDF has been restricted at the author's request. It will be publicly available after March 17, 2025.
Copyright
Status
Copyright protected
Availability
Status
Open
Reason
Permission or license
Back to the top
Technical
RULTechMD
(ID = TECHNICAL1)
ContentModel
ETD
OperatingSystem
(VERSION = 5.1)
windows xp
CreatingApplication
Version
1.7
DateCreated
(point = end);
(encoding = w3cdtf);
(qualifier = exact)
2022-12-06T11:55:09
DateCreated
(point = end);
(encoding = w3cdtf);
(qualifier = exact)
2023-01-04T15:35:23
ApplicationName
Microsoft® Word for Microsoft 365
Back to the top
Statistical Profile