Palliative care in emergency departments could improve patient care and reduce medical costs

Background: Adults with chronic illnesses frequently visit emergency departments (EDs) during their final years of life. These patients often undergo numerous invasive medical procedures in EDs, such as intubation, hemodialysis, or extracorporeal membrane oxygenation. Methods: To assess the effectiveness of palliative care in the ED, we investigated all patients who received palliative care in the ED and were subsequently admitted to the hospital in the period January to March 2023. Patients admitted from clinics (n = 8), discharged in the ED (n = 12), and hospitalized for more than 365 days (n = 1) were excluded. Results: A total of 84 patients received palliative care in the ED, whereas 145 received it after hospital admission. No significant differences were observed between these two groups in terms of age or gender. However, the ED referral group exhibited a significantly different distribution of primary indications for palliative care compared to the admission group (p = 0.046). The intensive care unit (ICU) admission rate was 15.5% in the ED referral group, and 40.0% in theadmission group (p < 0.001). The ward admission rate (75.0% vs. 75.2%, p = 0.549) of both group was similar, but palliative care ward admission rate (22.6% vs. 11.7%, p = 0.029) of both groups was significantly different. The mean medical cost of the ED group was 3435 USD, and that of the admission group was 9957 USD (p < 0.001). The mortality rate was 48.8% in the ED group and 62.8% in the admission group (p = 0.028). The rate of ventilator use while death occurred was 17.1% in the ED group and 37.8% in the admission group (p = 0.018). Conclusions: Our study shows that early palliative referral from the ED were related to reduced ICU admission rate, less suffering for the patient, and lower medical costs.

Emergency department; Palliative care; Hospice care; Hospice consultation; Medical cost; Quality of life; End-of-life treatment

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