Identification of the Hospice vs. Palliative Care Patient in the ED

Image Credit: Pexels

Author: Deniece Boothe, DO
Originally Published: Common Sense March/April 2019

The terms “hospice” and “palliative care” remain synonymous for many health care providers. Despite the intertwined relationship, it is important that we understand the differences in an effort to provide appropriate resources for our patients facing serious, life-limiting illness. Palliative care, also known as palliative medicine, is specialized medical care for people living with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness whatever the diagnosis. The goal is to improve quality of life for both the patient and the family.[1] Hospice care is designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life, rather than cure. Those with a prognosis of six months or less meet criteria for hospice. A Center to Advance Palliative Care survey found that most health care professionals erroneously equated palliative care with end-of-life (EOL) care.[1] This lack of understanding leads to ineffective communication between the provider and patient or health care proxy.

Delivering Bad News

Image Credit: Pixabay

Author: Niklas Eriksson, MSIV
Loyola University Chicago Stritch School of Medicine
AAEM/RSA Social Media Committee

This post was peer reviewed.
Click to learn more.

A variety of patients present in the emergency department (ED), and every ED physician, resident, and even student will encounter patients in critical condition or life-threatening injuries. As a result, it is an essential skill for an ED clinician to be able to give bad news. One of the more helpful mnemonics I have learned and been able to apply when having to break bad news to patients or their families is SPIKES. This mnemonic is often used by oncologists, but can apply equally well in the more acute ED setting.[1,2]

S: Setting. Make sure you are in an appropriate setting to deliver the news. A private room with minimal noise interference is preferable. A recent study showed that there is a discrepancy between patient and physician perspective on the level of privacy achieved during these conversations, indicating that more emphasis could be placed on finding an appropriate setting. [2,3] Also recognize the importance of introducing yourself and your role.[3,4]

P: Perception. Ask the patient and/or their family what their understanding of the transpired events has been thus far. It may be that the patient has been suffering from a chronic disease and they have been preparing for their eventual death for a long time, or this may be a sudden and unexpected occurrence. Many times it may be better to be direct. Overall, keep in mind that every family has different experiences with their loved ones and their diseases that makes each encounter different.

End of Life Care in the Emergency Department

Image Credit: Flickr

Author: Andrew W Phillips, MD MEd

Clinical Fellow, Division of Critical Care

Stanford University

 

We’ve all been there too many times: A terminally ill patient is rushed to the emergency department (ED) by ambulance in distress, either missing the Physician Orders for Life Sustaining Treatment (POLST) or the family instructs EMS to “do everything.” The ED staff begins to stabilize the patient: inotropes and pressors, central line, intubation, arterial line, pressure bagging, fluids — and then they are told to stop.

Now what? How do you allow the acutely ill patient to pass comfortably with dignity after you just did so many invasive, painful procedures? If there is no other place for the patient but the ED, here are some recommendations, based on literature and my personal experience, to make the patient’s final moments as comfortable as possible.

Preparation [1]

• Put the patient in a private room. The resuscitation bay is not the place to transition a patient to comfort care.

• Get social work, the chaplain, and/or palliative care involved to help with the “small” things that are meaningful (water, chairs for the family, calling family members, etc.) so you can focus on the patient.

• Determine what the most life-threatening physiology is for that patient – it is usually hypotension versus hypoxemia.