The Palliative Care Integration into the Emergency Medicine

Dr.Nurşah BaşolGaziosmanpasa University, Faculty of Medicine,

Department of Emergency Medicine Tokat, TURKEY

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Definition and Main Features of Palliative Care

Screening ToolsSymptomsReasons TrainingIntegration Models

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Introduction

Two billion older people by 2050Growth rate 2.6%

United Nations Department of Economic and Social Affairs. World population ageing. New York: United Nations, 2013.

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Aging population Development in medical care

Growing number of people living with chronic life-limiting illnesses.

Increased use of Emergency Department (ED) and hospitalization

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19 million people who had palliative care needs,

69% aged 60 years and above.

World Health Organization and Worldwide Palliative Care Alliance. Global atlas of palliative care at the end of life. London: Worldwide Palliative Care Alliance, 2014.

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Palliative Care

Why? Better quality of lifeWho? People with life-threatining illness and

familiesWhen? After diagnosis of illnessHow? Assessment and management of pain,

other physical problems, psychosocial issues and

spiritual needs

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Palliative CarePatient centered careNot necessary to draw immediate medical

actionsLess invasiveness in critical situationsDying is an expected outcome

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Emergency MedicineSymptom oriented approachFind the problemSolve it as soon as possible

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Emergency Department

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Screening Tools

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• Symptoms

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Reasons Serious uncontrolled symptomsSimple interventionsEmotional distressFear of death processProblems about family/caregiversLack of understanding avoidable health care facilitiesLowery D, Quest T. Emergency Medicine and Palliative Care.

Clin Geriatric Med 31(2015) 295-303.

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TrainingAssessment of illness trajectoryDetermination of prognosis, communicate

bad newsInterpretation and formation of an advance

care planSymptom management (both pain and

nonpain)Withdrawal and withholding of life-sustaining

treatments

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TrainingManagement of imminently dying patientsIdentify and implement hospice and palliative

care referrals and care plansUnderstanding of ethical and legal issues Display spiritual and cultural competency

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Avoidable ED Visits

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Institutional and Community Resources

 In-house palliative care team/unit availability and call schedules

Outpatient clinic availability and practice hours

Community hospice providers

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24/7 Chaplaincy support24/7 Social service supportBereavement supportEthics consultantChild life specialist support availability

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Institutional and Community Resources

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Early PC consultation in the ED impactsQuality of lifeHealth care utilizationSurvival

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Integration Models

Increased patient and family satisfactionReduction on costsDecreased LOSReduction on the intensity of careReduction in resuscitation rates

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Traditional consultation model Basic integration modelAdvanced integration modelED-focused advanced integration model

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Integration Models

Traditional Consultation ModelNo collaborative relationship to help integrate

PC principles into the ED care.Basic Integration Model

Formal working relationship between PC and ED

Mutual understanding of the processes and function

Agreed programmatic goalsPC training for ED Staff

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Advanced Integration ModelProtocols to identify patients Specific criteria for seeking a PC consultationPC-focused assessment and documentation

tools, communication encounters and transitions of care

ED-focused Advanced Integration ModelOne or more EM/palliative care dual-certified

physiciansCase management of high-risk PC populations

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SolutionsEmploying an ambulatory care

modelUsing direct admission proceduresDesignating special ward and ED

areas for such patientsBetter education about PC

Benefits of PC

Significant improvements in patient quality of life and mood

Increased patient and caregiver satisfactionDecreased ICU days, LOS, physical symptomsImproved resource usageReduction in health care costs

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Create Your Own Way

Institution-specific needsAvailability of local resources Ability of an existing PC program or hospice Local ED clinician culture

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Create Your Own Way

Training of ED Staff IdentificationNeeds AssesmentSymptom ManagementReferraling

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‘You matter because you are you. You matter to the last moment of your life, and we will do all we can , not only to help you die peacefully, but also to live until you die.’

Cicely Saunders (1918-2005) ‘The founder of modern hospice movement’

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Thank you!44