Empowering Emergency Department Nurses to Obtain Earlier Palliative Care Consults

Abstract

Session C presented Thursday, September 27, 1:00-2:00 pm Purpose: While the ED staff is trained to save lives, resuscitate and stabilize patients, all too often they are also faced with situations where aggressive care may not be the best way to meet a patient’s goals. Literature has shown that earlier referral to palliative care (PC) results in improved outcomes, more timely provision of care, reduced hospital length of stay (LOS), improved patient and family satisfaction, less utilization of intensive care and cost savings. The objectives of this project were to improve staff comfort levels in addressing a patient's goals of care and to increase the number of referrals to palliative care initiated in the ED. Design: This evidence-based project was a quality improvement initiative, with a goal of increasing the number of referrals made to the palliative care team, and to increase staff comfort levels in addressing End of Life wishes/goals of care. Setting: The setting is in the Emergency Department of a suburban teaching hospital. Participants/Subjects: All nurses working in the adult Emergency Department were a part of this project to screen patients for palliative care needs. A smaller group of ED resource nurses also participated in additional educational components of this project. Methods: An educational plan was developed including both didactic and hands-on elements to improve knowledge of palliative care, communication techniques and the clinical signs and symptoms of the dying patient. Role play scenarios were created and then used by professional actors to perform simulations where staff could hone their communication skills. A pre and post test was used to gauge staff knowledge of Goals of Care conversations and a likert test was used to determine their ease of dealing with EOL situations. An interdisciplinary group developed evidence-based screening criteria and approval was obtained from wider hospital management and physicians to allow nurses to use the screening tool as a basis for ordering palliative care consults. The screening tool was added to the ED EHR and is now utilized by nurses to screen patients for palliative care needs. The outcomes of this are measured numerically in reports on the number of consults generated and via questionnaires provided to nurses regarding their comfort level with addressing patients goals of care. Results/Outcomes: Preliminary findings indicate a large increase in the number of palliative care consults generated by the ED staff - from 8 in October 2016 to 35 in October 2017 and an increase in staff comfort levels in addressing the issue of goals of care. Implications: Palliative Care focuses on providing relief from the symptoms of a serious, life-limiting illness, including the management of pain and shortness of breath, with a goal of improving quality of life for both the patient and their family. By initiating PC consults in the ED the patient's goals of care are often addressed earlier in their hospital stay and care is then provided which aligns more closely with these goals. ED staff feel better equipped to tackle conversations about patient GOC and are empowered to effect meaningful interventions for those facing their last hours or days.