Palliative Care in the ED – The Time is Now

“Don’t delay engaging available palliative and hospice care services in the emergency department for patients likely to benefit.” This statement was one of ACEPs 2013 Choosing Wisely recommendations. How palliative care can be effectively and practically integrated into the ED, and which patients are likely to benefit from it is still being worked out at many institutions.1–4 However, it is clear that the time for palliative care in the ED has come. ACEP goes on to expand on their recommendation: “This is medical care that provides comfort and relief for patients who have chronic or incurable diseases. Early referral from the emergency department to hospice or palliative care services can benefit patients, resulting in both improved quality and quantity of life.” What is Palliative Care? First it is important to understand what palliative care is and isn’t. Palliative care is not equivalent to hospice care. Hospice care can only occur when a patient meets strict criteria that strongly predict death within 6 months. While we most often think about palliative care near the end of life, it is appropriate to offer it to patients as early as the time of diagnosis of a serious illness. Palliative care can occur concurrently with curative therapy, for symptom management, and can also continue once curative efforts have ceased and once a patient is on hospice. In some cases, palliative care can actually prolong life. The WHO defines palliative care as “care which improves the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosoial support from diagnosis to the end-of-life and bereavement.” The WHO further delineates palliative care as the following: provides relief from pain and other distressing symptoms; affirms … Continue reading Palliative Care in the ED – The Time is Now