Palliative Care in the Emergency Department

Betty R. Ferrell, PhD, RN, MA

Disclosures

January 30, 2014

Palliative Care in the ED

The first answer choice is the correct one. Given Harriett's history, she may benefit from palliative care expertise to assist in defining the goals of care and supporting her family in decision-making. Palliative care is becoming more common in EDs and other acute care settings. Although patients and families may at first associate palliative care only with end-of-life care, Harriet's family should be given an explanation about the role of palliative care and how they might be of assistance as they make choices about her care. Palliative care is appropriate in any serious or life-threatening illness, including stroke.

Palliative care teams in hospital settings are increasingly being used in EDs.[1] Their services can be valuable in efforts to help define the goals of care, offer assistance with symptom management, and in helping to avoid futile care. For example, in the case of Harriett, if the ED staff determines that her prognosis is poor, her family may decide to avoid life-prolonging treatments, admission to the neuro intensive care unit, or ventilator support. Instead they may elect to have Harriett admitted to the inpatient palliative care unit where the focus will be on quality-of-life issues, comfort care, and family support.

Palliative care teams may be called to the ED in many situations, including cases of accidents or trauma, symptom crisis such as uncontrolled pain, or many other urgent situations where comfort care is needed or where the goals of care may in fact suggest that life-prolonging strategies are to be avoided. Palliative care teams offer valuable medical and nursing support in EDs as well as social work and chaplaincy support.[2,3,4]

As hospitals face ever-increasing pressure to minimize costly admissions or unnecessary care, palliative care teams will play an even more important role in this setting.

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