Ideally, goals of care discussions do not happen for the first time when the patient presents to the ED. When goals of care conversations are held earlier in a patient’s disease course, advance care planning is possible. This can alleviate the use of aggressive interventions in the event the patient decompensates or does not make a meaningful recovery.
Palliative care should be integrated into serious illness care at any point following diagnosis. This can happen in conjunction with curative treatment, or as a standalone intervention focused on comfort at the end of life.
If a physician yells at a nurse or patient because of a disagreement over the treatment plan, involvement by human resources or another department is needed. But if a physician’s belligerence or disrespect affects someone’s decision-making, that is an ethical problem.
Ventura County, CA, paramedics underwent 30 hours of training on crisis counseling, grief, and palliative care. When EMS responded to a 911 call and determined a patient was in hospice, they contacted trained staff. During a three-year study period, the percentage of hospice patients transported to the ED was 36% in the first year, 33% in the second year, and 24% in the third year. This was compared to 80% of hospice patients transported, on average, during the six months before project implementation.
Researchers compared sociodemographic factors between patients admitted to an academic children’s hospital during ethics rounds in the PICU, PCTU, and NICU in 2017 and 2018 who were identified as having ethics issues and all other patients admitted to those same units during the same period. The researchers expected racial and/or socioeconomic differences between the groups, with socially vulnerable patients disproportionately identified as having ethical issues on rounds. But they did not find this to be the case.