P034: Identifying unmet palliative care needs in the emergency department

Abstract

Introduction: The goal of palliative care (PC) is to improve quality of life for both patients and families facing a life-limiting illness. Many individuals in need of PC present to the Emergency Department (ED) with symptomatic complaints. Therefore, the ED may be a good place to connect patients with PC teams. Unfortunately, a lack of communication between patients and medical teams may result in admission to hospital even if this no longer aligns with the goals of care. The aims of this study were to identify the proportion of ED patients with unmet PC needs and to determine if access to rapid outpatient PC follow-up could reduce unnecessary admissions. Methods: University Health Network (UHN) is an urban academic centre with EDs at two sites, Toronto General Hospital (TGH) and Toronto Western Hospital (TWH). A consecutively enrolled sample of 417 patients that presented to these EDs between July 1-August 14, 2018 was taken. ED nurses and physicians were asked to complete a content validated PC screening tool on all eligible patients. Patients were eligible for screening if they (1) were >18 years of age, (2) had been designated a level 2-5 according to the Canadian Triage and Acuity Score, and (3) had been triaged to the subacute or acute areas of the department. Results: Across both sites, 45% of patients screened had a life-limiting illness and 30% had unmet PC needs. Among those with unmet PC needs, 79% had no identifiable involvement with a PC team. TWH had fewer patients with a life-limiting illness compared to TGH (31% vs 57%), but higher rates of unmet PC needs (81% vs 59%, confidence interval for the difference: 8%-34%, p = .003) and less PC involvement (6% vs 24%, confidence interval for the difference: 4%-30%, p < .01). 73% of patients at UHN with unmet PC needs were likely to be admitted to hospital. In 14% (n = 17) of these cases, admissions were felt by physicians to have potentially been avoided if rapid PC follow-up was available. Conclusion: A high percentage of patients presenting to the EDs at UHN have life-limiting illnesses with unmet PC needs. A rapid access outpatient PC clinic, available for referral from the ED, may help to both connect patients with the resources they need and avoid admission to hospital.