Would You Be Surprised if This Patient Died in the Next 12 Months? Using the Surprise Question to Increase Palliative Care Consults From the Emergency Department

2019 ◽  
Vol 35 (4) ◽  
pp. 221-225 ◽  
Author(s):  
Henry Zeng ◽  
Paul Eugene ◽  
Mark Supino
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Palliative Care ◽  
Educational Intervention ◽  
Care Center ◽  
Educational Interventions ◽  
Sample Survey ◽  
Convenience Sample ◽  
Emergency Medicine Resident ◽  
Surprise Question

Background: There is a growing movement to increase palliative care consults from the emergency department (ED) to reduce healthcare costs and improve quality of life. The surprise question is a screening tool that emergency medicine physicians may be able to use towards achieving this goal. Objective: The objectives of this study were to increase awareness of hospice and palliative care medicine (HPM) among emergency medicine (EM) providers and to evaluate whether this heightened awareness increased palliative care consults among participating emergency medicine providers. Methods: We conducted an anonymous convenience sample survey and two educational interventions about HPM including the surprise question among emergency medicine resident and attending physicians at a large urban public academic quaternary care center from July to November 2018. A report of palliative care consults ordered between August 1, 2017 and January 1, 2019 was generated from the electronic health records used by the hospital. The number of palliative care consults made before and after the educational intervention was compared. Results: After the first educational intervention centered on the surprise question, palliative care consults from the ED increased from an average of 2.25 per month (range 0 to 8, SD: 2.38) to 12.67 per month (range 9 to 19, SD: 4.01, p < .001). Conclusion: Educating EM physicians about the surprise question can increase the number of palliative care consults from the ED, thereby potentially improving patient care and decreasing costs by avoiding unwanted healthcare interventions.

scholarly journals 1319. Examining PrEP Knowledge and Prescribing Likelihood Among Medical Residents Before and After PrEP Education

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S403-S403 ◽  
Author(s):  
Elizabeth Christian ◽  
Wendy Craig ◽  
Kinna Thakarar
Keyword(s):  
Internal Medicine ◽  
Educational Intervention ◽  
Care Center ◽  
Tertiary Care ◽  
Knowledge Score ◽  
Medical Residents ◽  
Convenience Sample ◽  
Before And After ◽  
Student’S T ◽  
Motivating Factor

Abstract Background Pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but prescribing rates remain low. We examined the effect of an educational intervention on PrEP knowledge and prescribing likelihood among medical residents. Methods This was a prospective study using a convenience sample of Internal Medicine and Internal Medicine-Pediatrics residents at a tertiary care center in Portland, Maine. Participants attended a resident-led teaching session on PrEP and completed pre- and post-session surveys. PrEP knowledge was measured with five questions (definition, evidence, patient selection criteria, medication choice, and guidelines), and prescribing likelihood was assessed on a Likert scale. Participants identified motivating factors and barriers to prescribing. Survey data were analyzed with McNemar’s test or a paired Student’s t test as appropriate. Results Thirty residents completed the study; of these, 24 (83%) had at least 1 patient that they considered at high risk for HIV, and 14 (46%) reported having &gt;5 such patients. None had ever prescribed PrEP. Average PrEP knowledge score increased after the intervention (pre = 2.33 vs. post = 4.1, P &lt; 0.001). After the intervention, more participants reported that they would be likely to prescribe PrEP (pre = 76% vs. post = 90%, P = 0.014), fewer identified unfamiliarity with PrEP guidelines as a barrier (pre = 73% vs. post = 27%, P &lt; 0.001), and Òother residents are prescribing PrEPÓ became a significant motivating factor (pre = 47% vs. post = 70%, P = 0.04). Preceptor comfort with prescribing PrEP was a consistently important influence on prescribing likelihood (90% vs. 82%, P = 0.22). Conclusion Familiarity with PrEP is relevant to resident practice, and an educational intervention is effective in the short term for addressing inadequate knowledge as a barrier to offering PrEP. Resident practice is influenced by preceptors and peers, suggesting that it may be helpful to include attending physicians in future PrEP education efforts at our institution. Disclosures All authors: No reported disclosures.

226 Palliative Care Domains for Emergency Medicine Resident Training: An Expert Consensus

2015 ◽  
Vol 66 (4) ◽  
pp. S83 ◽  
Author(s):  
R. Goett ◽  
J. Shoenberger ◽  
P. DeSandre ◽  
K. Jubanyik ◽  
K. Aberger ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Palliative Care ◽  
Resident Training ◽  
Expert Consensus ◽  
Emergency Medicine Resident ◽  
Medicine Resident

scholarly journals Emergency Medicine Resident Education in Palliative Care: A Needs Assessment

2010 ◽  
Vol 39 (2) ◽  
pp. 333-334 ◽  
Author(s):  
Sangetta Lamba ◽  
Anne Mosenthal ◽  
Joseph Rella ◽  
Amy Pound ◽  
Thomas Driscoll ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Palliative Care ◽  
Needs Assessment ◽  
Resident Education ◽  
Emergency Medicine Resident ◽  
Medicine Resident

scholarly journals Death in the Emergency Department: A Retrospective Analysis of Mortality in a Swiss University Hospital

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Eric P. Heymann ◽  
Alexandre Wicky ◽  
Pierre-Nicolas Carron ◽  
Aristomenis K. Exadaktylos
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Palliative Care ◽  
Retrospective Analysis ◽  
Clinical Severity ◽  
University Hospital ◽  
Advanced Directives ◽  
Risk Of Death ◽  
Public Data ◽  
Patients At Risk

Acute treatment in emergency medicine revolves around the management and stabilization of sick patients, followed by a transfer to the relevant medical specialist, be it outpatient or inpatient. However, when patients are too sick to be stabilized, i.e., when the care provided in the Emergency Department (ED) may not be sufficient to enable transfer, death may occur. This aspect of emergency medicine is often overlooked, and very few public data exist regarding who dies in the ED. The following retrospective analysis of the mortality figures of a Swiss university hospital from January 1st 2013 to December 31st 2016 attests to the fact that with an incidence of 2.6/1,000, death does occur in the ED. With a broad range of aetiologies, clinical severity at presentation has a high correlation with mortality, a finding that reinforces the necessity of good triage system. Our analysis goes on to show that however (in)frequent death in the ED may be, there exists a lack of advanced directives in a majority of patients (present in only 14.8% of patients during the time of study), a worrying and often challenging situation for Emergency Medicine (EM) teams faced with premorbid patients. Furthermore, a lack of such directives may hinder access to palliative care, as witnessed in part by the fact that palliative measures were only started in 16.6% of patients during the study. The authors hope this study will serve as a stepping stone to promote further research and discussion into early identification methods for patients at risk of death in the ED, as well as motivate a discussion into the integration of palliative care within the ED and EM training curriculum.

Emergency Medicine Resident Education in Palliative Care: A Needs Assessment

2012 ◽  
Vol 15 (5) ◽  
pp. 516-520 ◽  
Author(s):  
Sangeeta Lamba ◽  
Amy Pound ◽  
Joseph G. Rella ◽  
Scott Compton
Keyword(s):  
Emergency Medicine ◽  
Palliative Care ◽  
Needs Assessment ◽  
Resident Education ◽  
Emergency Medicine Resident ◽  
Medicine Resident

Palliative care in the emergency department: A survey assessment of patient and provider perspectives

2020 ◽  
Vol 34 (9) ◽  
pp. 1279-1285
Author(s):  
Emily J Woods ◽  
Alexander D Ginsburg ◽  
Fernanda Bellolio ◽  
Laura E Walker
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Palliative Care ◽  
Response Rate ◽  
Healthcare Providers ◽  
Care Utilization ◽  
Provider Perspectives ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Emergency Department Patients

Background: Palliative care has been identified as an area of low outpatient referral from our emergency department, yet palliative care has been shown to improve the quality of patient’s lives. Aim: This study investigates both provider and patient perspectives on palliative care for the purpose of identifying barriers to increased palliative care utilization within our healthcare system. Design: Two surveys were developed, one for patients/caregivers and one for healthcare providers. Setting/participants: This was a single-center study completed at a quaternary academic emergency department. A survey was sent to emergency medicine providers with 47% response rate. Research staff approached Emergency Department patients who had been identified to be high risk to fill out paper surveys with 76% response rate. Results: Only 28% of patients had already undergone palliative care, with an additional 25% interested in palliative care. Nearly half of the patients felt that they needed more resources to prevent hospital visits. Patients identified low understanding of palliative care and difficulty accessing appointments as barriers to consultation. Among providers, 98% indicated that they had patients who would benefit from palliative care. A majority of providers highlighted patient understanding of palliative care and access to appointments as barriers to palliative care. Notably, 52% of providers reported that emergency medicine provider knowledge was a barrier to palliative care consultation. Conclusions: Despite emergency department patients’ self-identified need for resources and emergency medicine providers’ recognition of patients who would benefit from palliative care, few patients receive palliative care consultation.

Emergency Medicine Physicians' Perspectives of Providing Palliative Care in an Emergency Department

2011 ◽  
Vol 14 (12) ◽  
pp. 1333-1338 ◽  
Author(s):  
Susan C. Stone ◽  
Sarita Mohanty ◽  
Corita R. Grudzen ◽  
Jan Shoenberger ◽  
Steve Asch ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Palliative Care
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