Increasing Goals of Care Review and Fiscal Implications With an Embedded Palliative Care Specialist in the Emergency Department: A Quality Improvement Project at a Community-Based Hospital

Patients with terminal illnesses presenting to the emergency department (ED) may be admitted to the hospital receiving aggressive treatment that will not reverse the dying process and is not aligned with their wishes. Misdirected, incongruous care negatively impacts the comfort of the patient and increases health care costs. This project aimed to determine if embedding a palliative care nurse practitioner in the ED at a community-based hospital is a meaningful method for addressing goals of care early in the preadmission period, with the potential secondary benefit of improved fiscal health of the system. A preintervention and postintervention EPIC (electronic medical record) review was done to evaluate change in readmission rates, hospice and palliative care referrals, and advance care planning sessions. The target population was adults presenting to the ED with an expected mortality within 6 months. An EPIC-generated report compared how many similar patients, during the same month, 1 year prior (November 2022), explored goals of care in the ED (as evidenced by above measures). Exploring goals of care in the ED for patients with terminal illnesses may lead to a more comfortable death and result in better utilization of resources, reduced unnecessary admissions, and cost savings to the hospital system.