ED Physicians Have the Tools and the Mandate to Identify Hospice Patients

Historically, our medical system has functioned under the assumption that hospitalization means receiving the most aggressive care available. Then, upon discharge, we might discuss goals of care.

But Medicare ground rules are changing; discharge planning and identifying the seriously ill are imperative. ED clinicians are tasked with incorporating palliative care principles into daily ED practice using tools like the following:

• Five Things Physicians and Patients Should Question¹ from the American Board of Internal Medicine’s “Choosing Wisely” initiative 
• CARING criteria predictors are finding a role in that practice

The CARING tool helps identify patients with advanced disease, citing criteria to identify those likely to die within a year. From it we learn that, by reviewing an individual’s history and current health, we can make some predictions on mortality.

ID the Sickest Patients

These changes are demanding that clinicians be more proactive. In the ED, we are identifying the sickest and least likely to recover, then having a goals-of-care discussion instead of putting patients through the rigors of an aggressive hospital admission.

“Emergency physicians should engage patients who present to the ED with chronic or terminal illness—and their families—in conversations about palliative care and hospice services,” ACEP advises. “Early referral from the ED to hospice and palliative care services can benefit patients, improving quality and quantity of life.”³

¹http://www.choosingwisely.org/societies/american-college-of-emergency-physicians/

²http://www.ncbi.nlm.nih.gov/pubmed/16632076

³”Making the Rounds” Vol. 5 Issue 2, page 3, American College of Emergency Physicians Advocates Hospice Discussion, VITAS Healthcare 2015