title: Hospital administrators' views on barriers and opportunities to delivering palliative care in the emergency department.
abstract: OBJECTIVE
  We identify hospital-level factors from the administrative perspective that affect the availability and delivery of palliative care services in the emergency department (ED).
  
  
  METHODS
  Semistructured interviews were conducted with 14 key informants, including hospital executives, ED directors, and palliative care directors at a tertiary care center, a public hospital, and a community hospital. The discussions were digitally recorded and transcribed to conduct a thematic analysis using grounded theory. A coding scheme was iteratively developed to subsequently identify themes and subthemes that emerged from the interviews.
  
  
  RESULTS
  Barriers to integrating palliative care and emergency medicine from the administrative perspective include the ED culture of aggressive care, limited knowledge, palliative care staffing, and medicolegal concerns. Incentives to the delivery of palliative care in the ED from these key informants' perspective include improved patient and family satisfaction, opportunities to provide meaningful care to patients, decreased costs of care for admitted patients, and avoidance of unnecessary admissions to more intensive hospital settings, such as the ICU, for patients who have little likelihood of benefit.
  
  
  CONCLUSIONS
  Though hospital administration at 3 urban hospitals on the East coast has great interest in integrating palliative care and emergency medicine to improve quality of care, patient and family satisfaction, and decrease length of stay for admitted patients, palliative care staffing, medicolegal concerns, and logistic issues need to be addressed.
authors: Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA. corita.grudzen@mssm.edu
authors: Corita R
authors: CR
authors: Grudzen
authors: Lynne D
authors: LD
authors: Richardson
authors: Hannah
authors: H
authors: Major-Monfried
authors: Brandon
authors: B
authors: Kandarian
authors: Joanna M
authors: JM
authors: Ortiz
authors: R Sean
authors: RS
authors: Morrison
mesh_terms: D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006740:Hospital Administrators; D006764:Hospitals, Community / Q000379:methods / Q000458:organization & administration; D006779:Hospitals, Public / Q000379:methods / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D010166:Palliative Care / Q000331:legislation & jurisprudence / Q000379:methods / Q000458:organization & administration; D062606:Tertiary Care Centers / Q000458:organization & administration; D014481:United States