Emerging palliative care innovations in the ED : a qualitative analysis of programmatic elements during the Covid-19 pandemic

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AARONSON, Emily Loving | DAUBMAN, Bethany-Rose | PETRILLO, Laura | BOWMAN, Jason | OUCHI, Kei | GIPPS, Alexa | TRAEGER, Lara | JACKSON, Vicki | GRUDZEN, Corita | RITCHIE, Christine Seel

CONTEXT: Health systems have aspired to integrate palliative care (PC) into the emergency department (ED) in order to improve care quality for over a decade, yet there are very few examples of implemented models in the literature. The COVID-19 pandemic led to an increase in the volume of seriously ill patients in EDs and a consequent rapid increase in PC integration in many EDs. OBJECTIVE: To describe the new PC-ED delivery innovations that emerged during the COVID-19 pandemic. METHODS: For this qualitative study of PC programs in EDs, semi-structured interviews were conducted with ED and PC clinicians between June 30, 2020 and August 18, 2020. Participants were asked about PC-ED integration before, during and after COVID. We conducted a two-phased rapid analysis (RA) using a RA template and consolidated matrix to identify innovations. RESULTS: Using purposive and snowball sampling, we interviewed 31 participants, representing 52 hospitals. Several new innovations in care delivery were identified. These included elements of fully embedded PC, the use of PC extenders, technology both within the electronic medical record (EMR) and outside of it, and innovations in training emergency clinicians in primary palliative care skills to support care delivery. Most PC efforts focused on increasing goals of care conversations. Institutions that implemented these programs reported that they increased PC utilization in the ED, were well received by clinicians, and changed patient's care trajectories. CONCLUSIONS: Several new innovations in PC-ED care delivery emerged during COVID. Many innovations leveraged different types of clinicians to deliver care, an increased physical presence of PC in the ED, and used technology to enhance care delivery. These innovations may serve as a framework for institutions as they plan for evolving needs in the ED during and after COVID. Additional research is needed to evaluate the impact of these programs and to understand their applicability beyond the pandemic.

http://dx.doi.org/10.1016/j.jpainsymman.2020.10.035

Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT»

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