As the percentage of the U.S. population older than age 65 years expands, “the need for palliative medicine is likely to continue to increase,” says Nathan Haas, MD, clinical assistant professor in the department of emergency medicine at the University of Michigan.
However, palliative interventions in the ED often prove challenging. Barriers include limited time, pressure to maintain patient throughput, and competing clinical demands. This frequently results in patients near the end of life moving from the ED to the ICU.
In the ICU, says Haas, “goals of care conversations often result in treatment focused on palliation rather than life extension.”
In 2015, the University of Michigan opened the Emergency Critical Care Center, an ED-based ICU. If ED patients near the end of life receive care in this setting, some ICU admissions can be prevented.1 Of 218 patients near the end of life treated in the ED-ICU from December 2015 to March 2020, only two were admitted to the ICU, and 22 were discharged home from the ED-ICU. “In the absence of the ED-ICU, it is likely that the majority — or all — of these patients would have been admitted to the ICU,” Haas says. For patients and families, the ED-ICU means avoiding costly ICU admissions that do not align with care goals. For health systems, it means alleviating ICU capacity strain.
“This study adds to the growing body of literature that palliative interventions can be effectively delivered in the ED setting, to best provide care in line with patients’ goals of care, and to reduce downstream resource utilization,” Haas says.
- Leith TB, Haas NL, Harvey CE, et al. Delivery of end-of-life care in an emergency department-based intensive care unit. J Am Coll Emerg Physicians Open 2020;1:1500-1504.