Triggering and Increasing Palliative Care in the Emergency Department

Purpose The purpose of this project is to increase the knowledge and comfort base of ED providers in identifying patients with palliative care needs in the ED setting by using The Emergency Department Palliative Care Trigger Tool. PICOT /Scholarly question PICOT question: Does the implementation of Emergency Department Palliative Care Trigger Tool (EDPCTT) increase the number of referral rates by 20% in the ED within eight weeks? Project Description The project aimed to increase the number of palliative care consultations directly from the ED. The project recruited twenty-five ED providers composed of ED physicians, registered nurses and registered nurse case managers. The participants were given pre-test survey questionnaires to examine their comfort and knowledge level regarding patients who met criteria for palliative care. An education intervention was delivered through a Power Point presentation. Participants were educated on EDPCTT and they were informed the tool would become part of the ED providers’ workflow. Post-test survey questionnaires were distributed to examine the effectives of the intervention. Palliative care metrics at the practicum site were reviewed before and after the intervention. Results The results of the project achieved the intended purpose of educating ED providers’ care and integration of a palliative care trigger tool in the ED to increase consults. Participants were educated on palliative care and their knowledge and comfort was evaluated before and after the intervention. The results showed that the education was very effective in identifying patients who were appropriate for early palliative care. Weekly rounds were established in the ED and have become the routine practice for palliative care. Communication between ED providers increased significantly. The ED witnessed an increase in the number of patients who are diverted from the ED to hospice by 50% and 400% increase in the number of patients admitted on comfort measures only. Furthermore, after the education, the volume of consultations originating from the ED increased by 173%. The palliative care revenue increased tremendously and met the revenue expectations. The only challenge brought about by the project was that the implementation of the project resulted in the large volume of consults from the ED of which the palliative care team was not staffed to meet the demands. Palliative care providers found themselves working long hours to keep up with the consults. Implications to nursing / Healthcare ED providers are the gatekeepers of quality care in acute care centers. Educating ED providers on palliative care improves knowledge and comfort level of palliative care, thereby eliminating the barriers to timely palliative care consults in the ED. DNP-prepared leaders must advocate for quality projects that promote the integration of palliative care in the ED. Offering palliative care at the beginning of the hospital course decreases length of stay by facilitation of timely discharge planning based on patients’ preferences of care, reduction in cost and increased palliative care revenue as more palliative care consultations are initiated in the ED instead of during inpatient stay when relationships with families are difficult to establish as patients may be preparing for discharge. Having palliative care in the ED will break the barrier of its use because explanation of services is presented accurately by the palliative care providers in the ED. Patients are seen by several specialists in the hospital and communication with families may be interrupted. Initiating palliative care from the ED promotes interdisciplinary collaboration and communication right as the patients access the hospital system. 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