Palliative care in emergency departments is bringing a critical shift in the end-of-life experience.

Every year there are over 137 million visits to hospital emergency departments (EDs) in the United States. Adults 65 and older use the ED more than any other age group, and half of older adults will visit the ED in the last month of their lives.

Emergency departments in the U.S. are the primary hospital entry point for end-of-life care. One in 10 people die in the emergency room. Emergency medicine clinicians are very good at what they do: they resuscitate, stabilize and save lives. For many patients, this model of care is exactly what they want and need. However, for individuals who are terminally ill, such aggressive and invasive interventions are often futile. They can be traumatic and may go against the patient’s wishes.

But thanks to a creative group of clinicians and other thought leaders, a revolution has been occurring, one hospital at a time. Practitioners, facilities and healthcare systems have been offering palliative care consults right in the ED.

Palliative care is specialized medical care for people living with a serious illness. With a focus on providing relief from the symptoms and stress associated with the illness and a goal to improve quality of life for both the patient and the family. Palliative treatments can be offered with any illness and at any stage of life, even while working to cure that illness, or can be part of comfort care for those who are facing a terminal diagnosis.

By working together, emergency and palliative medicine practitioners can provide patients with the opportunity to talk openly about their health goals. As a result, clinicians in the ED can offer the appropriate treatments and forgo those treatments the patient doesn’t want, as well as connect the patient to the appropriate planning and supportive services upon discharge, where available.

Compassion & Choices is supporting this practice with a brand-new National Emergency and Palliative Medicine Initiative (NEPMI). The program brings together physicians, nurses, social workers, chaplains, end-of-life doulas and caregivers from all over the country to share best practices and data. The goal of this collaboration is a profound shift from unwanted, expensive “one-size-fits-all” care in the ED to patient-directed care as people approach the end of life.

“If the ED is to continue to be the primary portal of hospital entry for patients requiring emergent care for acute and chronic terminal illnesses, then … it should also be equally prepared to provide the earliest access to palliative care and advance care planning resources for patients and families who may want and benefit from these services,” said Dr. Satheesh Gunaga, vice chair of emergency medicine at Henry Ford Wyandotte Hospital in Michigan and a member of the Compassion & Choices board of directors.

Because the ED uniquely impacts individuals of all racial, ethnic, socio-economic and religious backgrounds like no other clinical venue in medicine, the NEPMI initiative will seek to address long-standing inequities in end-of-life care, like the lower-than-average adoption of hospice services by diverse communities.

Clinical nurse coordinator Beka Malloy and clinical social worker Alejandra Muro co-developed a palliative-emergency medicine initiative in 2021 at Providence Little Company of Mary Medical Center in Torrance, California. Compassion & Choices invited them to participate in NEPMI and share their experiences. “We were both delighted and excited to be a part of the NEPMI initiative as it was an opportunity for us to take the successful model that we created within our health system and see it potentially be replicated across the country,” said Malloy.

“One of the most rewarding parts of this initiative is the coming together of diverse perspectives and thoughts to create a space in which emergency medicine and palliative care services come together from all angles,” added Muro. “Not just the medicine, but the emotional and spiritual care.”

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