Patient Characteristics and Different Decision Paths for Establishing Palliative Care for Patients Admitted via the Emergency Department

<b>Background:</b> Up to 10% of emergency department (ED) patients present with palliative care needs. Despite rising demand for palliative expertise in acute care, ED processes for these patients remain heterogeneous, and data from German EDs are limited. <b>Methods:</b> This retrospective cohort study included all patients presenting to the ED of a 754-bed academic hospital in 2023 who were later admitted to the palliative care ward. Demographics, symptom burden at ED and palliative care admission, length of stay (LOS), and discharge outcomes were analyzed after ethics approval (EK 24-062). Patients transferred to palliative care later during hospitalization (group 1) were compared with those directly transferred after ED treatment (group 2). <b>Results:</b> Among 229 included patients, 190 were identified as group 1 and 39 as group 2 patients. Demographics and cancer prevalence were comparable (68.4% vs. 69.2%). In group 1, fatigue, neurological symptoms, dyspnea, and anxiety/restlessness significantly increased during hospitalization, while anxiety/restlessness decreased significantly in group 2. Before palliative admission, LOS in group 1 was 15.2 ± 13.9 days; 36.8% required intensive or stroke unit care. LOS in the palliative ward (8.0 ± 6.6 vs. 9.3 ± 10.3 days, <i>p</i> = 0.45) and discharge alive rates (27.1% both groups) did not differ. <b>Conclusions:</b> Early recognition and management of palliative needs in the ED may reduce symptom burden. Once specialized palliative care was established, LOS and mortality were comparable across groups, highlighting the value of standardized assessments for early identification and integration of palliative care in acute settings.