Goals of Care Conversations Documented by an Embedded Emergency Department-Palliative Care Team during COVID

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Background: There has been growing interest around integrating palliative care (PC) into emergency department (ED) practice but concern about feasibility and impact. In 2020, as the COVID pandemic was escalating, our hospital's ED and PC leadership created a new service of PC clinicians embedded in the ED. Objectives: To describe the clinical work of the embedded ED-PC team, in particular what was discussed during goals of care conversations. Design: Prospective patient identification followed by retrospective electronic health record chart extraction and analysis. Settings/Subjects: Adult ED patients in an academic medical center in the United States. Measurements/Results: The embedded ED-PC team saw 159 patients, whose mean age was 77.5. Nearly all patients were admitted, 48.0% had confirmed or presumed COVID, and overall mortality was 29.1%. Of the patients seen, 58.5% had a serious illness conversation documented as part of the consult. The most common topics addressed were patient (or family) illness understanding (96%), what was most important (92%), and a clinical recommendation (91%). Clinicians provided a prognostic estimate in 57/93 (61.3%) of documented discussions. In the majority of cases where prognosis was discussed, it was described as poor. Conclusion: Specialist PC clinicians embedded in the ED can engage in high-quality goals of care conversations that have the potential to align patients' hospital trajectory with their preferences.

Aaronson, Emily LHarvard Medical School (författare)
Petrillo, Laura AHarvard Medical School (författare)
Jacobsen, Juliet CLund University,Lunds universitet,Lungmedicin, allergologi och palliativ medicin,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Respiratory Medicine, Allergology, and Palliative Medicine,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Harvard Medical School(Swepub:lu)ju6087ja (författare)
Harvard Medical SchoolLungmedicin, allergologi och palliativ medicin (creator_code:org_t)

Ingår i:Journal of Palliative Medicine: Mary Ann Liebert Inc26:5, s. 662-6661096-62181557-7740

Av författaren/redakt...: Bowman, Jason K; Aaronson, Emily ...; Petrillo, Laura ...; Jacobsen, Juliet ...

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