Original ContributionsInitiating Palliative Care in the Emergency Department
Introduction
In 2006, nearly a quarter of a million patients arrived dead or died in the Emergency Department (ED) (1). Managing the actively dying and providing relief from suffering falls directly under the purview of Emergency Medicine. Quest et al. identified 12 palliative care skills that Emergency Physicians (EPs) should learn to manage patients effectively in the ED: assess illness trajectory, formulate prognosis, communicate bad news, plan advanced care, resuscitate the terminally ill with family members present, manage pain and non-pain symptoms, withdrawal and withholding of care, manage the imminently dying, manage hospice patients and palliative care systems referrals, understand ethical and legal issues pertinent to end-of-life care, display spiritual and cultural competency, and manage the dying child (2). Despite this, further education in end-of-life care and its role in the ED are clearly needed (3). Currently, fewer than 18% of residents and medical students receive formal end-of-life care education, and there is a paucity of end-of-life care information in medical textbooks 4, 5.
We use a case presentation to illustrate how palliative care (PC) can frequently be incorporated into ED care, but is often overlooked. The case is representative of patients seen in EDs every day across the country and is used as a framework to discuss key issues in PC in the ED.
Section snippets
Definitions
The American Academy of Hospice and Palliative Medicine defines the goal of PC as “to prevent and relieve suffering and to support the best possible quality of life for patients facing life-threatening or debilitating illness and their families, regardless of the stage of the disease or the need for other therapies” (6). The World Health Organization defines PC as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening
Incorporating Palliative Care into the ED: An Illustrative Case
A 62-year-old Hispanic woman presented to the ED in respiratory distress. The patient did not speak English, but her caregivers, her two oldest daughters, were at the bedside to translate. Upon entering the room, the oldest daughter said that her mother, “has lung cancer and she was just discharged from the hospital yesterday.” She stated that after her mother’s chemotherapy treatment that morning she did not feel well and the Internal Medicine service evaluated her in the Cancer Center and
Conclusion
As the American population continues to age and there are increasingly older Americans with chronic and terminal illnesses, EPs will be at the forefront of emergent symptom management for the near dead and the actively dying. EPs should learn effective management strategies and how to appropriately refer patients to PC.
The under-utilization of PC services throughout the health care system has drastic implications for patients, their families and caregivers, and the system as a whole. PC
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