Palliative Care Screening and Assessment in the Emergency Department: A Systematic Review.
BACKGROUND
Emergency department (ED) providers and policy makers are increasingly interested in developing palliative care (PC) interventions for ED patients. Many patients in the ED may benefit from PC screening and referral. Multiple ED-based PC screening projects have been undertaken, but there has been no study of these projects or their effects.


OBJECTIVE
To conduct a systematic review and critical analysis to evaluate the methods, tools, and outcomes of PC screening and referral projects in the ED.


METHODS
Three reviewers independently selected eligible studies from the PubMed database. Eligible studies evaluated a PC screening tool, assessment, or referral modality aimed at identifying patients appropriate for PC. Four reviewers independently evaluated the final articles. Two reviewers extracted data on study characteristics, methodological quality, and outcomes.


RESULTS
Seven studies met inclusion criteria. Each was reviewed for methodological quality and strength. The studies were synthesized using a narrative approach. Each study developed an independent screening or evaluation tool for PC needs. Each required additional ED personnel to perform screening and referral, and success was limited by availability of specialized personnel. All the studies were successful in increasing rates of PC referral.


CONCLUSIONS
We have identified multiple studies demonstrating that screening and referral for PC consultation are feasible in the ED setting. The strengths and limitations of these studies were explored. Further evidence for the development of an effective, evidence-based PC screening, and referral process is needed. We recommend a screening framework based on a synthesis of available evidence.
Brown University Alpert Medical School, Providence, Rhode Island, USA. Electronic address: nrgeorge@gmail.com.
Naomi
N
George
George Washington University, Washington, DC, USA.
Elizabeth
E
Phillips
Mount Sinai School of Medicine, New York, New York, USA.
Milana
M
Zaurova
Mount Sinai School of Medicine, New York, New York, USA.
Carolyn
C
Song
New Jersey Medical School, Newark, New Jersey, USA.
Sangeeta
S
Lamba
New York University Langone Medical Center, New York, New York, USA.
Corita
C
Grudzen
D004632:Emergency Medical Services / Q000379:methods; D004636:Emergency Service, Hospital; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D012017:Referral and Consultation
Emergency Department; palliative care; referral; screening; systematic review