Identification of Unmet Palliative Care Needs in the Emergency Department: A Quality Improvement Project
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Authors
Nystrom, Marci
Issue Date
2025-05-16
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Type
Manuscript
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Keywords
Emergency Department , Palliative Care , Quality of Life , P-Cares
Alternative Title
Abstract
Purpose: Implementation of a nurse-led screening tool to identify the unmet needs of palliative care (PC) in the emergency department (ED) setting for patients 65 years of age and older.
Background: PC improves the quality, service, and efficiency of care for acute and chronically ill patients and their families. Early implementation of PC could benefit patients, allowing for decreased hospital visits, lower healthcare costs, and increased quality of life. PC resources are less available in critical access facilities compared to larger hospitals.
Sample/Setting: Adults 65 years and older who present to a rural Midwestern critical access ED during a 6-week project period.
Methods: The Palliative Care and Rapid Emergency Screening (P-CaRES) tool, a validated screening tool utilized in the ED to identify patients' unmet needs, was implemented in the ED to identify unmet PC needs. Baseline data was collected for four weeks pre-implementation of the P-CaRES and usage data for six weeks post-implementation by reviewing the screening tool results in the electronic medical records (EMR).
Results: 181 P-CaRES screenings were completed post-implementation on patients 65 and older presenting to the ED. 92 (50.8%) were completed correctly by the ED RN on arrival to the ED, and 89 (49.2%) were completed by the primary investigator. Of the compliant screenings completed by the ED RN, 29 (16.0%) screened positive, and 63 (34.8%) screened negative. The completed screenings by the primary investigator revealed higher positive results. Of these screenings, 53 (29.3%) reflected positive results, and 36 (19.9%) resulted in negative. There was no significant pre vs post differences in rates of positive nurse-led screening χ2= 0.00088, df =1, p-value = 1). Rates of positive screens were strikingly similar (Pre= 45.139%, 95%CI = 36.840%-53.641%; Post = 45.304%, 95%CI = 37.906%-52.858 %). Rates of staff compliance were close to 50% (50.8, 95%CI = 43.31%-58.32%). Of the screens done by staff, 29/92 (31.52%, 95%CI = 22.22%-42.043%) were positive.
Conclusion: Findings from this study reflect that the populations of patients screened were not different between the pre- and post-implementation phases. The results showed no significant difference in pre- vs. post-rates of positive nurse-led screenings; positive screens were surprisingly similar. This positive outcome supports increased PC needs and detection/screenings. If completed correctly upon arrival to the ED, the P-CaRES is proven to increase detection and identification of unmet PC needs in the ED. This would be an appropriate screening tool for ED patients 65 and older who would benefit from palliative care services.
Keywords: emergency department, palliative care, quality of life, patient, identification, P-CaRES, length of stay, chronic illness, recognition.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University