Should the ED offer palliative care? Depends who you ask

Hospital leaders, emergency physicians may disagree

Topics: Emergency Department, Service Lines, Complementary and Alternative Medicine

July 26, 2012

Hospital administrators generally believe that EDs should offer palliative care but tend to face strong resistance from one group: their own emergency physicians.

Researchers from the Mount Sinai School of Medicine recently polled hospital leaders on how their EDs incorporate palliative care, which focuses on comforting terminal patients and recognizing their end-of-life wishes rather than attempting to prolong their lives as much as possible. However, emergency physicians seem to resist adopting palliative care as part of the medical treatment, the administrators told researchers in interviews.

In their study, which appears in the Annals of Emergency Medicine this month, researchers concluded that emergency physicians:

  • May lack the time needed to address just how much intervention each individual patient desires.
  • Worry that even if they respect a patient's final wishes, they may still face malpractice suits for not doing everything within their power to save the patient's life.
  • May assign a stigma to palliative care—that it is the same as end-of-life care—and might regard such care as giving up or do not consider it a part of saving lives.

However, geriatrics and palliative care researcher Alexander Smith of the University of California (who was not involved in the study) told Reuters that physicians can offer palliative treatment alongside life-prolonging care and not as a substitution for it. He adds that palliative care needs to rebrand itself among emergency physicians for it to be incorporated into the ED.

Hospital administrators say that educating emergency physicians about palliative care would likely encourage them to consider it. Additionally, establishing guidelines for determining a patient's palliative needs would improve access to such care.

Incentive for offering palliative care in the ED

The study highlighted potential incentives for EDs to offer palliative care:

  • It can improve patient and family satisfaction;
  • It can prevent unnecessary admissions to more expensive and intensive hospital settings, such as the ICU.
However, study author Corita Grudzen does not believe that EDs are prepared to deliver palliative care, in part because there are too few palliative specialists to staff every ED (Grens, Reuters, 7/24).

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