title: Preliminary report of a palliative care and case management project in an emergency department for chronically ill elderly patients.
abstract: The Palliative Care Service at Montefiore Medical Center (MMC) established a pilot project in the emergency department (ED) to identify chronically ill older adults in need of palliative care, homecare, and hospice services and to link such patients with these services. Two advance practice nurses conducted consultations on elderly patients who were found to have one or more "palliative care triggers" on initial screening. A standardized medical record abstraction form was developed. Service utilization and survival were evaluated using the Clinical Information Systems of MMC. Activity of daily living items were developed from the Outcome and Assessment Information Set and the Palliative Care Performance Scale (PPS). Risk factors for hospitalization and use of the ED were taken from the SIGNET model risk screening tool. Physical and emotional symptoms were evaluated using the 28-item Memorial Symptom Assessment Scale short form. Preliminary outcomes and characteristics are presented for 291 patients who completed the intake needs assessment questionnaire. Almost one third (30.9%) of the study cohort died during the project period. Most of the deaths occurred beyond the medical center (7.7% died in the medical center and 23.3% outside the medical center). Thirty percent of patients who died were enrolled on a hospice. Survival time was predicted by the presence of dyspnea, clinician prediction of death on the current hospitalization, psychosocial distress, and PPS scores. Chronically ill patients visiting an urban community ED had complex medical and psychosocial problems with limited support systems and homecare services. Significant proportions of such patients can be expected to have limited likelihood of survival. The presence of palliative homecare and hospice outreach services in the ED in urban community hospitals may provide an effective strategy for linkage of elderly patients at the end of life with otherwise underutilized services.
authors: Palliative Care Service, Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3335 Steuben Avenue, Bronx, NY 10467, USA. somahony@montefiore.org
authors: Sean O'
authors: SO
authors: Mahony
authors: Arthur
authors: A
authors: Blank
authors: Janice
authors: J
authors: Simpson
authors: Judy
authors: J
authors: Persaud
authors: Bernadette
authors: B
authors: Huvane
authors: Susan
authors: S
authors: McAllen
authors: Michelle
authors: M
authors: Davitt
authors: Marlene
authors: M
authors: McHugh
authors: Allen
authors: A
authors: Hutcheson
authors: Serife
authors: S
authors: Karakas
authors: Philip
authors: P
authors: Higgins
authors: Peter
authors: P
authors: Selwyn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000458:organization & administration*; D002908:Chronic Disease / Q000401:mortality / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000458:organization & administration*; D006699:Home Care Services; D017051:Hospice Care / Q000458:organization & administration*; D006738:Hospices / Q000379:methods / Q000639:trends; D006801:Humans; D008297:Male; D009518:New York; D010166:Palliative Care / Q000379:methods* / Q000639:trends; D010865:Pilot Projects; D012307:Risk Factors; D016019:Survival Analysis