Palliative Care Evidence Table 2.19.20 (1)
docx
keyboard_arrow_up
School
University of Michigan *
*We aren’t endorsed by this school
Course
BOOTCAMP
Subject
Medicine
Date
Jan 9, 2024
Type
docx
Pages
5
Uploaded by UltraTeamFly30
EVIDENCE TABLE Focused Question:
Palliative Care Consults in the ED
Completed by: Gina S. Welch RN, BSN, CEN / Providence St. Patrick Hospital
Completed for: EBP Project Author/Year
Aim/Research
Question
Design/Method
Sample/Setting
Limitations
Intervention
Findings
JHNEBP
Evidence
Rating
Wilson,J., English, D. Owyang, C. Chimelski, E., Grudzen, C. Wong, H., Aslakson, R, et. al(2019)
Efficacy of ED-based Palliative Care (PC) interventions. To evaluate the effects of
PC interventions in the ED on patient-
reported or family reported outcomes, health care utilization or survival
Retrospective database Literature review. (PubMed, Embase, Web of Science, Scopus and the Cumulative Index to Nursing and Allied Health Literature) 3091 abstracts, 98 full-text articles reviewed with 13 articles selected for final inclusion
Pediatric patient studies excluded. Non-English language published articles excluded. Excluded studies which only screened for PC needs. Methodologies all limited d/t retrospective, descriptive or quasi-
experimental nature. PC interventions or referral in the ED, as compared to usual ED care.
Existing data support the PC in the ED is feasible, may improved quality of life,
and does not appear to affect survival, compared with usual care
Level III/B
Revels, A., Watson,J. (2016)
Examine the current provision of palliative care in the emergency department
Literature Review
Not well defined. Literature review was
extensive, but not well quantified. Article was mostly opinion based on literature review and heavily laden with personal bias and wishful thinking. Watson’s caring science used, vs. Standard practice “The historically fast-paced, lifesaving environment of the emergency department places emphasis on needs that are distinctly opposite of that which palliative care patients so often require”
The use of caring science as a framework for palliative
care in the emergency department may inspire change within this unique area of nursing practice
Level V/C
Fermia, R., Wilkins, C., Rodriguez, D., Read, K., Gavin,N.,Caspers
, C.,MD, Jamin, C. (2016)
Evaluate cost savings
and reduction in LoS r/t Palliative Care referrals originating in
the Emergency Department
A retrospective chart review was conducted on all ED patients who received a palliative care consult in 2014 at Ronald O. Perelman Center for Emergency Services at the New York ED MDs initiated 226
PC consults in 2014. 40 were directly admitted to a hospice
program from the ED.
Twenty-four of these patients were admitted to our inpatient hospice and
Inability to capture costs associated with
patients discharged from ED to other inpatient hospice programs. Lack of information related to
the acuity of the patient’s ED initiated PCC vs. Standard ED care
Patients who had an ED-
initiated PCC with resultant hospice placement and a LOS > 2 days, the average LOS was 5.5 days and the average direct cost per case
was $5,856. If the PCC was initiated outside of the ED with eventual hospice Level III/B
1
Author/Year
Aim/Research
Question
Design/Method
Sample/Setting
Limitations
Intervention
Findings
JHNEBP
Evidence
Rating
University School of Medicine
16 were placed in either home hospice or another facility’s hospice unit.
presentation to the ED, which may have affected the MDs perception of the patient’s outcome.
placement, the average LOS was 8.6 days and the average direct cost per case
was $15,431.
Our findings suggest significant benefits from ED-initiated palliative care consultation in decreasing variable direct costs and shortening length of stay. Rigorous studies are needed to help identify additional potential benefits of ED-initiated palliative care referral
Di Leo,S., Alquati,
S., Autelitano, C., Costantini, M., Martucci, G., De Vincenzo,F., Kuczynska, B., Morini, A., Trabucco, L., Ursicelli, R., Catania, G., and Ghirotto, L.(2019)
Exploring issues in delivering palliative care in the Emergency Department from the perspective of both providers and users (As part of a larger QI
project program in Italian Emergency Departments.)
A qualitative study involving focus group interviews with Emergency Department professionals and semi-structured interviews with patients
with palliative care needs in the Emergency Department and their relatives was conducted. Both datasets were analyzed using Thematic Analysis.
21 healthcare professionals, (4 physicians, 12 nurses, 5 nursing assistants) 6 patients
and 5 relatives. Five themes were identified: 1) shared priorities in ED among healthcare professionals and patients, 2) information provided by healthcare professionals vs. desired by relatives, 3) perception of environment and time, 4) limitations and barriers to the continuity of care, and 5) the contrasting Study participants were recruited at a single center, acknowledged as a research hospital in the discipline of oncology and equipped with a Palliative Care Unit. This may affect the generalizability of our
findings. FGs were attended by fewer participants than expected; nevertheless, we gathered a considerable amount
of information from different professionals working within all three ED units. Our Palliative Care in this ED. Interviews about patient (n=6) and family (n=5) perception of palliative care in the ED and focus group style interviews with health care professionals (n=21)
The present qualitative study reveals how PC is acknowledged in the ED, but still far from a full and addressable integration
Subject interviews?
2
Author/Year
Aim/Research
Question
Design/Method
Sample/Setting
Limitations
Intervention
Findings
JHNEBP
Evidence
Rating
interpretations of giving and receiving palliative care. Participant type, N (%) Patient 6 (54.5) Relative 5 (45.5).
Setting: ED of a 900-bed public research Hospital in Northern Italy
study was performed
on patients and relatives of patients having moved from ED to another hospital department. We did not know if their feedback could be different in case of discharge. Patients and relatives seemed to show some difficulties in focusing
the time of stay in the ED (recall bias).
(George et al., 2016)
To conduct a systematic review and
critical analysis to evaluate the methods,
tools, and outcomes of PC screening and referral projects in the
ED
Systematic Review of the literature. Meta-
analysis
Seven articles found for review by three independent reviewers
Exclusions criteria ruled out pediatric patients focusing on adult. Articles were used from facilities in
the Northeast U.S. limiting national data.
Screening techniques varied between articles. Establishing palliative care interventions in the emergency department Palliative care feasible and can offer benefits to patients
but there is no standardized methods or tools to establish palliative care interventions. Availability of dedicated palliative care staff can be a barrier. Level II/B
(Kostenberger et al., 2019)
Determine how many patients seen in the emergency room in Carinthia, Austria meet criteria of having
palliative symptoms and whether they have received palliative care over a two-week span. Qualitative Meta-
synthesis study.
1096 patients screened in the Emergency room for palliative care symptoms
Limited time (Two weeks) doing the palliative care screening tool. Staff educated on using screening tool. Time limitations in busy emergency room.
Using palliative care screening tool to assess palliative symptoms upon being seen in triage in the emergency department. Screening patient records after emergency room visit to determine if palliative care consults were done. One in ten patients in the emergency room had palliative symptoms. 5.5% of patients with palliative symptoms received a palliative care consult. Level III/B
3
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
Author/Year
Aim/Research
Question
Design/Method
Sample/Setting
Limitations
Intervention
Findings
JHNEBP
Evidence
Rating
(Kistler et al., 2020)
To conduct a systematic review of published trigger tools
for palliative care consults (PCC) in the emergency room and inpatient units to determine if trigger criteria for palliative care consults can be improved or standardized. Systematic review of the literature using meta-analysis
164 studies were examined by paired reviewers. 20 studies
(Over 17,000 patients) were considered for final analysis. Conclusions are limited to methods, reporting and quality in palliative care consults only. Limited to English publications only. Limited time to more recent publications. Articles that met criteria couldn’t be considered because full-texts versions couldn’t be obtained.
Limited to adults only.
Identify palliative care process, trigger criteria and study bias of publications that detailed palliative care consults in the inpatient units and emergency department. Future, high quality and preferably randomized trials are needed to elucidate best
practices and to delineate between patients requiring primary versus specialty palliative care services.
Nurses acted as primary initiator of trigger tools. Positive trigger criteria (Not automatically doing PCC but
suggesting a possible one) was present on 40% of patients in these 20 studies.
Level II/B
(Grudzen et al., 2010)
To identify the needs of a palliative care consult for seriously ill
patients in a 41-bed emergency room.
Cross-sectional study
92 patients interviewed with 53 eligible for a palliative
care survey. 50 participants elected to enroll in a palliative
care consult. Limitations in a busy emergency room with palliative care staff availability concerns. Sample size did not include all seriously ill people. Small sample size limiting testing criteria
Palliative care surveys given to patients that met criteria of being critically ill to determine if they met and/or wanted to enroll for a
palliative care consult. All surveys were done in the emergency department
57% of patients interviewed were eligible for a palliative care survey. Palliative care consults in the emergency room were high compared to patients interviewed. Future data will be needed to determine effectiveness of palliative care consults in the ED. Level V/B
4
Author/Year
Aim/Research
Question
Design/Method
Sample/Setting
Limitations
Intervention
Findings
JHNEBP
Evidence
Rating
References:
George, N., Phillips, E., Zaurova, M., Song, C., Lamba, S., & Grudzen, C. (2016, January). Palliative Care Screening and Assessment in the Emergency Department: A Systematic Review. Journal of
Pain and Symptom Management
, 51
(1), 108-119. doi:https://doi.org/10.1016/j.jpainsymman.2015.07.017
Grudzen, C., Richardson, L., Morrison, M., Cho, E., & Morrison, S. (2010, November). Palliative care needs of seriously ill, older adults presenting to the emergency department. Academic Emergency Medicine
, 17
(11), 1253-1257. doi:10.1111/j.1553-2712.2010.00907
Kistler, E. A., Stevens, E., Scott, E., Philpotts, L. L., Greer, J. A., & Greenwald, J. L. (2020, February). Triggered Palliative Care Consults: A Systematic Review of Interventions for Hospitalized and Emergency Department Patients. Journal of Pain and Symptom Management
, 74-79. doi:10.1016/j.jpainsymman.2020.02.001
Kostenberger, M., Neuwersch, S., Weixler, D., Pipam, W., Zink, M., & Likar, R. (2019, August). Prevalence of palliative care patients in emergency departments. Wiener klinische Wochenschrift
, 131
(17), 404-409. doi:10.1007/s00508-019-1530-5
5