243592 Provision of Palliative Care in an Urban Emergency Department

Sunday, October 30, 2011

Katrina Kubicek, PhDc , Division of Research on Children, Youth and Families, Childrens Hospital Los Angeles, Los Angeles, CA
Sarita Mohanty, MD, MPH , COPE Health Solutions, Los Angeles, CA
Jocelyn Supan, MPH , Community, Health Outcomes, and Intervention Research Program, Children's Hospital Los Angeles, Los Angeles, CA
Jan Shoenberger, MD , Dept. of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
Suan Stone, MD , Department of Emergency Medicine, Cedars Sinai Medical Center, Los Angeles, CA
Background: Patients in the emergency department (ED) frequently present at the end-of-life. Historically, the ED is geared to provide diagnosis and treatment for acute illness. This environment provides challenges when a palliative approach is needed. Little is known regarding how ED providers view palliative care. This study explores medical professionals' attitudes towards palliative care.

Methods: Semi-structured qualitative interviews were conducted with ED physicians (residents n=11, attending n=12) at a large urban ED. Interviews lasted approximately 45-60 minutes and were analyzed for themes that emerged.

Results: Interviews identified key perceived benefits (e.g., patient/family comfort; increased understanding of end-of-life needs; self-determination in end-of-life decisions). Challenges were identified (e.g., time; lack of pain management expertise; lack of patient follow-up; palliative care often at odds with core tenets of emergency medicine). Respondents felt palliative care is important but is often omitted due to the functional limitations of the ED. Training in this area (e.g., palliative care rotation; increased presence of palliative care team in ED; checklist of patient needs to ensure palliative care is more consistently offered to patients in need) were identified as solutions.

Conclusions: ED providers felt palliative care is important and identified various benefits and challenges to providing palliative care in an ED setting. With many uninsured and publicly insured individuals presenting at EDs for primary care (for routine complaints as well as pain management of chronic disease), palliative care is becoming more common in this setting. Thus, additional training and exposure may be beneficial for emergency medicine practitioners.

Learning Areas:
Chronic disease management and prevention
Provision of health care to the public

Learning Objectives:
Discuss benefits and challenges of providing palliative care in an emergency setting

Keywords: Chronic Illness, Access to Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I designed the interview guide, conducted the analysis and summarized the results.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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