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Making the Rounds

Break the Cycle; Send them Home

11/25/2015

Increased use of ED and hospital services, coupled with progressive worsening of symptom burden and functional decline, are strong indicators that your patient could benefit from palliative care. Using your best medical judgment, answer the question:

“Would it surprise me if this patient was not with us in the next six months?”

Your answer will further clarify hospice appropriateness.

Stress on ED Providers

ED physicians should feel empowered and honored to introduce treatment options to patients they have identified as near the end of life. ED throughput, hospital readmissions and other quality metrics are putting enormous stress on ED providers and the acute care system to provide quick, efficient, high-value care to patients.

But as people live longer and medical technology improves, EDs are seeing older patients with multiple, advanced, chronic illnesses that progress simultaneously through our best treatments—until they don’t. Then our ED staff is confronted with uncontrolled pain, dyspnea, delirium and functional decline that result from the progression of heart failure, COPD, vascular disease or any combination thereof. Dementia complicates the picture, especially if goals of care and advance directives have not been addressed. The patient becomes an ED “frequent flyer,” leading to challenges with wait times, throughput, observation utilization and boarding.

Offering Patients Better Lives

By identifying these patients early in the ED/hospital cycle and promptly referring them to palliative care or hospice, we offer them better lives. They are at home, wherever they call home. An interdisciplinary team brings all necessary clinical services to them. With no more panicked 9-1-1 calls, quality of life improves. Their families receive support. Our EDs focus on emergent care. And we begin to break the cycle.