A Rapid Two-Stage Screening Protocol for Palliative Care in the Emergency Department: A Quality Improvement Initiative

Abstract Background A rapid two-stage screening protocol was developed to improve referral for palliative care needs among frail elderly in the emergency department (ED). Measures A new triage tool was administered, with assessment tools for activities of daily living, performance, functional stagin...

Full description

Saved in:
Bibliographic Details
Published in:Journal of pain and symptom management 2011-11, Vol.42 (5), p.657-662
Main Authors: Glajchen, Myra, DSW, Lawson, Robin, LMSW, Homel, Peter, PhD, DeSandre, Paul, DO, Todd, Knox H., MD
Format: Article
Language:English
Subjects:
Accident and emergency departments
Activities of Daily Living
Aged
Aged, 80 and over
Anesthesia & Perioperative Care
Caregivers - psychology
Caretaker syndrome
Cost of Illness
emergency department
Emergency Service, Hospital - organization & administration
Emergency Service, Hospital - standards
Female
Frail Elderly
hospice referral
Hospices
Humans
Male
New York City
Pain Medicine
Palliative care
Palliative Care - methods
Palliative Care - organization & administration
Palliative Care - standards
palliative care screening
Patient Care Team
Psychological distress
Psychomotor Performance
Quality Improvement
Rapid QI
Referral and Consultation
Referrals
Screening
Social Work
Triage
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Background A rapid two-stage screening protocol was developed to improve referral for palliative care needs among frail elderly in the emergency department (ED). Measures A new triage tool was administered, with assessment tools for activities of daily living, performance, functional staging, symptom burden, and caregiver distress. Intervention Stage One identified elderly patients meeting criteria for life-limiting conditions. Stage Two referred patients with crescendo losses in activities of daily living, high symptom burden, and caregiver distress to palliative care or hospice. Outcomes Over eight months, 1587 patients were screened, representing 22% of ED visits made by patients older than 65 years during this time period. Of these, 140 met functional decline criteria, and 51 of these needed palliative care consultation. Five patients were referred to hospice, 20 received palliative care, and 26 received no further service. Conclusions/Lessons Learned The project shows unmet needs among elderly ED patients, and the feasibility of rapid screening and referral using a quality improvement approach. At its peak, the project accounted for half the referrals to the palliative care consultation service.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2011.06.011