Palliative Care in the Emergency Department

Betty R. Ferrell, PhD, RN, MA


January 30, 2014

Case Presentation

Harriett S. is an 87-year-old woman who has been a resident of a long-term care (LTC) facility for the past 6 years. She is a widow and has 2 children, both of whom live out of state. She has a history of hypertension and had a mild stroke a year ago. She is now being transferred from her LTC facility to a local emergency department (ED) because she has developed symptoms of another stroke, including inability to communicate and weakness on her left side. The LTC facility staff reported by phone to the ED that Harriett's son is her proxy decision-maker, although he hasn't seen his mother in 2 years. She does not have an advance directive. They also report that Harriett has had frequent episodes of extreme fatigue, dyspnea, and weakness over the past 2 months and that they believe that, overall, she has been declining significantly. The ED nurse who received the report from the LTC facility suggests to the ED physician that perhaps the palliative care team should be notified.


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