title: A rapid two-stage screening protocol for palliative care in the emergency department: a quality improvement initiative.
abstract: BACKGROUND
  A rapid two-stage screening protocol was developed to improve referral for palliative care needs among frail elderly in the emergency department (ED).
  
  
  METHODS
  A new triage tool was administered, with assessment tools for activities of daily living, performance, functional staging, symptom burden, and caregiver distress.
  
  
  METHODS
  Stage One identified elderly patients meeting criteria for life-limiting conditions. Stage Two referred patients with crescendo losses in activities of daily living, high symptom burden, and caregiver distress to palliative care or hospice.
  
  
  RESULTS
  Over eight months, 1587 patients were screened, representing 22% of ED visits made by patients older than 65 years during this time period. Of these, 140 met functional decline criteria, and 51 of these needed palliative care consultation. Five patients were referred to hospice, 20 received palliative care, and 26 received no further service.
  
  
  CONCLUSIONS
  The project shows unmet needs among elderly ED patients, and the feasibility of rapid screening and referral using a quality improvement approach. At its peak, the project accounted for half the referrals to the palliative care consultation service.
authors: Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York 10003, USA. mglajchen@chpnet.org
authors: Myra
authors: M
authors: Glajchen
authors: Robin
authors: R
authors: Lawson
authors: Peter
authors: P
authors: Homel
authors: Paul
authors: P
authors: Desandre
authors: Knox H
authors: KH
authors: Todd
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D017281:Cost of Illness; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards*; D005260:Female; D016330:Frail Elderly; D006738:Hospices; D006801:Humans; D008297:Male; D009519:New York City; D010166:Palliative Care / Q000379:methods* / Q000458:organization & administration / Q000592:standards*; D010348:Patient Care Team; D011597:Psychomotor Performance; D058996:Quality Improvement; D012017:Referral and Consultation; D012947:Social Work; D014218:Triage