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
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