Compassion & Choices Initiative Brings the Benefits of Palliative Care Into the Emergency Room

Oct 24, 2022

Perhaps unsurprisingly, emergency room visits tend to increase as people approach the end of life. Emergency departments are the primary portal of hospital entry for the terminally ill, and people over age of 65 have higher emergency department use than any other group. In fact, 50% of older adults will visit the emergency department in their last month of life. Full end-of-life care, however, is not currently easy to access in this setting. Compassion & Choices has launched the National Emergency and Palliative Medicine Initiative (NEPMI) to help change that.

“The majority of older adults prefer quality of life rather than life extension, yet most do not have advance directives at the time of an emergency department visit and are at risk of receiving care inconsistent with their goals,” says Compassion & Choices Director of Medical Outreach Robert Drake. “For this reason, the emergency department needs to be prepared to offer palliative care and advance care planning in addition to the current default of lifesaving care.” 

Among the goals of NEPMI are to emphasize the importance of end-of-life conversations and the place of palliative care in the emergency department, and to remedy the communication gap between care teams that negatively impacts patient care at the end of life. Compassion & Choices plans to act as a convener in this process, offering expert guidance from our network of medical professionals and providing an online resource hub full of tools to help physicians and patients with proactive communication and preparation. Because although 88% of emergency medicine physicians agree on the need for palliative care training, only half report having received any.

“We want to help people avoid dying in the emergency department or, unnecessarily, in ICUs without knowing about hospice or palliative care, or having end-of-life conversations and advance directives,” explains Drake. “Part of it is getting physicians to ask themselves the ‘surprise question’: Would I be surprised if this patient died within six months? If the answer is no, it should trigger a palliative care consult, which triggers end-of-life conversations and collaboration with an interdisciplinary team of doctors, nurses, social workers and chaplains, just as it does in hospice. There are palliative care teams that are trained to have these conversations. The challenge is to get this happening and get the ‘surprise question’ into emergency departments.”

Feedback about NEPMI has been enthusiastic across the country. Because many hospitals, especially small community hospitals, do not have palliative care teams, Compassion & Choices’ role as a convener would help pull together experts and best practices to provide those missing skills. “Ultimately, it might involve coordinating with providers that can take a call from an emergency department at three in the morning and have a doctor, nurse or social worker who is trained in this to call them back within an hour and get the process started,” says Drake. “So the potential impact for huge swaths of the population saving in suffering, saving in costs, saving in the heartache of dying in ICUs away from your family with all these unwanted heroic interventions is huge.”