Emergency Department-triggered Palliative Care in XXXX : Proof of Concept.

@entity1 @entity5 @entity616
BACKGROUND: The American College of Emergency Physicians and the American Society of Clinical Oncology recommend early palliative care consultation for @entity1 with advanced, life-limiting illnesses, such as @entity5 . OBJECTIVES: The objectives were to assess the process of early referral from the emergency department (ED) to palliative care for @entity1 with advanced, incurable @entity5 as part of a randomized controlled trial and to compare the proportion and timing of consultation to a care as usual group. METHODS: A single-blind randomized controlled trial (ClinicalTrials.gov ID NCT01358110) compared early, ED-based referrals to palliative care for @entity1 admitted with advanced, incurable @entity5 to physician-driven consultation (i.e., care as usual). @entity1 had to speak English or Spanish and have no history of palliative care consultation. They were randomized via @entity616 randomization to the intervention or control group. Each intervention subject was referred by a research staff member to the palliative care team for consultation. The usual care group received palliative care only if requested by the admitting physician. Analysis was based on intention to treat. A chart review was performed to assess proportion and timing of palliative care consults during the index admission, defined as: 1) completed palliative care consult documented in the chart and 2) days from admission to palliative care consult. RESULTS: A total of 134 @entity1 were enrolled and randomized. For @entity1 in the intervention group, 88% (60 of 68) had documented palliative care consultations during their index admissions (95% confidence interval [CI]  =  80.5 to 95.5), compared to 18% (12 of 66) in the control group (95% CI  =  8.8 to 27.5; p < 0.01). The 60 intervention @entity1 received palliative care consultations on average 1.48  days from admission (95% CI  =  1.19 to 1.76), compared to 2.9  days from admission in the 12 control @entity1 (95% CI  =  1.03 to 4.79; p  =  0.15). CONCLUSIONS: This study documented a low baseline rate of palliative care involvement as part of usual care in @entity1 with @entity5 being admitted from the ED. Early referral to palliative care in the context of a research study significantly increased the likelihood that @entity1 received a consult, thus meriting further investigation of how to generalize this approach.
