Abstract
Background
The emergency department (ED) is often where patients with advanced illness (AI) present
when faced with an acute deterioration in their disease.
Objectives
To investigate the effectiveness of our AI Management program in the ED on key outcomes.
Methods
We conducted a pre-post study with a retrospective chart review with ED patients at
an academic, tertiary care hospital in the New York metropolitan area. We assessed
changes from baseline to intervention period on percent of patients identified in
the ED with AI, percent who received an ED-led goals-of-care (GOC) discussion, and
percent referred to hospice from the ED. We used the Fisher's exact test or the Mann-Whitney
test to compare groups, as appropriate.
Results
Our sample consisted of 82 patients (21 baseline and 61 intervention). Patients in
the baseline period had a median age of 75 years, with 61.9% being female, whereas
those in the intervention period had a median age of 83 years, with 67.2% being female.
Patients in the intervention, compared with baseline, were significantly more likely
to be identified as having AI in the ED (90.2% vs. 0.0%; p < 0.0001), to receive an ED-led GOC conversation (83.6% vs. 0.0%; p < 0.0001), and to be discharged to home hospice (39.3% vs. 0.0%; p < 0.0001).
Conclusions
The ED provides a critical opportunity to identify AI patients, have ED-led GOC discussions,
and refer appropriate patients to hospice.
Keywords
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Article info
Publication history
Published online: October 06, 2017
Accepted:
August 8,
2017
Received in revised form:
June 22,
2017
Received:
February 27,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
