Patients present to the emergency department with critical and complex medical conditions that require a broad scope of medicine to achieve patient outcomes. Emergency medicine physicians are recognizing the importance and positive outcomes that arise when palliative care teams are consulted in the emergency room. Today, medical schools, residency programs, and emergency departments are requiring palliative care curriculum apart of their education. However,
there continues to be a gap in early initiation of palliative care in emergency medicine. Nurse practitioners are becoming pivotal in the emergency department, and patients are considering them key providers in their medical journey. The role of an advanced practice nurse in an emergency room may be optimal for the early onset of palliative care consultation. This manuscript examines current
knowledge that explores the background of palliative care, the current practice in the emergency department, the positive outcomes and gaps that still exist today, and the increasing role of an advanced practice nurse in the emergency room and their impact on palliative care initiation.
References
[1]
Perrin, K.O. and Kazanowski, M. (2015) Overcoming Barriers to Palliative Care Consultation. Critical Care Nurse, 35, 44-52. https://doi.org/10.4037/ccn2015357
[2]
Mierendorf, S.M. and Gidvani, V. (2014) Palliative Care in the Emergency Department. The Permanente Journal, 18, 77. https://doi.org/10.7812/TPP/13-103
[3]
Meier, D.E. and McCormick, E. (2015) Benefits, Services, and Models of Subspecialty Palliative Care. UpToDate.
[4]
Grudzen, C.R., Stone, S.C. and Morrison, R.S. (2011) The Palliative Care Model for Emergency Department Patients with Advanced Illness. Journal of Palliative Medicine, 14, 945-950. https://doi.org/10.1089/jpm.2011.0011
[5]
Atreya, S. (2016) Early Integration of Palliative Medicine into Emergency Care: Is it a Feasible Option. Indian Journal of Medical and Paediatric Oncology: Official Journal of Indian Society of Medical & Paediatric Oncology, 37, 202.
https://doi.org/10.4103/0971-5851.190360
[6]
Salins, N., Deodhar, J. and Muckaden, M.A. (2016) Intensive Care Unit Death and Factors Influencing Family Satisfaction of Intensive Care Unit Care. Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 20, 97. https://doi.org/10.4103/0972-5229.175942
[7]
Norton, S.A., et al. (2007) Proactive Palliative Care in the Medical Intensive Care Unit: Effects on Length of Stay for Selected High-Risk Patients. Critical Care Medicine, 35, 1530-1535. https://doi.org/10.1097/01.CCM.0000266533.06543.0C
[8]
Kyeremanteng, K., et al. (2018) The Impact of Palliative Care Consultation in the ICU on Length of Stay: A Systematic Review and Cost Evaluation. Journal of Intensive Care Medicine, 33, 346-353. https://doi.org/10.1177/0885066616664329
[9]
Khandelwal, N., et al. (2015) Estimating the Effect of Palliative Care Interventions and Advance Care Planning on ICU Utilization: A Systematic Review. Critical Care Medicine, 43, 1102. https://doi.org/10.1097/CCM.0000000000000852
[10]
Morrison, R.S., et al. (2011) Palliative Care Consultation Teams Cut Hospital Costs for Medicaid Beneficiaries. Health Affairs, 30, 454-463.
https://doi.org/10.1377/hlthaff.2010.0929
[11]
May, P., Normand, C. and Morrison, R.S. (2014) Economic Impact of Hospital Inpatient Palliative Care Consultation: Review of Current Evidence and Directions for Future Research. Journal of Palliative Medicine, 17, 1054-1063.
https://doi.org/10.1089/jpm.2013.0594
[12]
Smith, A.K., et al. (2009) Am I Doing the Right Thing? Provider Perspectives on Improving Palliative Care in the Emergency Department. Annals of Emergency Medicine, 54, 86-93.
[13]
Fassier, T., et al. (2016) Who Am I to Decide Whether This Person Is to Die Today? Physicians’ Life-or-Death Decisions for Elderly Critically Ill Patients at the Emergency Department-ICU Interface: A Qualitative Study. Annals of Emergency Medicine, 68, 28-39. e3.
[14]
Grudzen, C.R., et al. (2012) Does Palliative Care Have a Future in the Emergency Department? Discussions with Attending Emergency Physicians. Journal of Pain and Symptom Management, 43, 1-9.
https://doi.org/10.1016/j.jpainsymman.2011.03.022
[15]
Limehouse, W.E., et al. (2012) A Model for Emergency Department End-of-Life Communications after Acute Devastating Events—Part II: Moving from Resuscitative to End-of-Life or Palliative Treatment. Academic Emergency Medicine, 19, 1300-1308. https://doi.org/10.1111/acem.12018
[16]
DeCoste-Lopez, J., Madhok, J. and Harman, S. (2015) Curricular Innovations for Medical Students in Palliative and End-of-Life Care: A Systematic Review and Assessment of Study Quality. Journal of Palliative Medicine, 18, 338-349.
https://doi.org/10.1089/jpm.2014.0270
[17]
Von Gunten, C.F., et al. (2012) Development and Evaluation of a Palliative Medicine Curriculum for Third-Year Medical Students. Journal of Palliative Medicine, 15, 1198-1217. https://doi.org/10.1089/jpm.2010.0502
[18]
Goldonowicz, J.M., Runyon, M.S. and Bullard, M.J. (2018) Palliative Care in the Emergency Department: An Educational Investigation and Intervention. BMC Palliative Care, 17, 43. https://doi.org/10.1186/s12904-018-0293-5
[19]
Kistler, E.A., et al. (2015) Emergency Department-Triggered Palliative Care in Advanced Cancer: Proof of Concept. Academic Emergency Medicine, 22, 237-239.
https://doi.org/10.1111/acem.12573
[20]
Practintioners A.A.o.N. (2018) What’s a Nurse Practitioner (NP)?
https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner
[21]
Laurant, M.G., et al. (2008) An Overview of Patients’ Preference for, and Satisfaction with, Care Provided by General Practitioners and Nurse Practitioners. Journal of Clinical Nursing, 17, 2690-2698.
https://doi.org/10.1111/j.1365-2702.2008.02288.x
[22]
Rosenzweig, M., et al. (2008) Patient Communication Simulation Laboratory for Students in an Acute Care Nurse Practitioner Program. American Journal of Critical Care, 17, 364-372.