Palliative Care in Emergency Departments: Addressing the Needs of Seriously Ill Older Adults

Among people aged 65 and older, half visited the emergency department (ED) in the last month of their lives, and three in four visited the ED during the 6 months before their deaths. However, emergency care has not adapted to meet these patients’ needs, with palliative care teams, present in two-thirds of hospitals, not typically available in EDs for crisis response. A new study, published in the Journal of the American Medical Association and conducted by researchers from Memorial Sloan Kettering Cancer Center, New York University Grossman School of Medicine, and Tibor Rubin Long Beach Veterans Affairs, evaluates the effect of a multicomponent intervention to initiate palliative care in the ED on hospital admission rates for older adults with serious, life-limiting illnesses. This research was supported by the National Center for Complementary and Integrative Health and other components of the National Institutes of Health (NIH) within the NIH Pragmatic Trials Collaboratory.

Palliative care is specialized medical care aimed at providing relief from the symptoms, pain, and stress of a serious illness to improve the quality of life for patients and their families. Many studies have shown that palliative care improves symptoms and the quality of end-of-life care for people with a broad range of illnesses.

This study employed a cluster-randomized stepped-wedge clinical trial design and included patients aged 66 and older who visited one of 29 EDs across the United States between May 2018 and December 2022, had a Gagne comorbidity score (a predictor of 1-year mortality) above 6, and were enrolled in Medicare for at least 12 months. The intervention involved four components: evidence-based multidisciplinary education, simulation-based workshops on serious illness communication, clinical decision support, and feedback for ED clinical staff. The main outcome measure was hospital admission, with secondary measures including subsequent health care use and 6-month survival.

The study found that the intervention did not significantly impact hospital admissions, subsequent health care use, or short-term mortality among this population. Admission rates were 64.4 percent during the pre-intervention period versus 61.3 percent post-intervention, contrasting previous studies demonstrating the effectiveness of specialized palliative care.

Research is limited in the areas of primary palliative care and palliative care delivered by clinicians who are not specialists in the field. This study highlights the challenges of implementing comprehensive palliative care in emergency settings, especially during the COVID-19 pandemic, which affected staffing and training capacity. The findings underscore the need for continued research and innovative strategies to enhance palliative care integration in emergency departments, ultimately improving care and quality of life for seriously ill older adults.