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Palliative care in the emergency department: A qualitative study exploring barriers, facilitators, desired clinician qualities, and future directions

Published online by Cambridge University Press:  08 July 2021

Alexa Gips Open the ORCID record for Alexa Gips [Opens in a new window] ,
Bethany-Rose Daubman ,
Laura A. Petrillo ,
Jason Bowman ,
Kei Ouchi ,
Lara Traeger ,
Vicki Jackson ,
Corita Grudzen ,
Christine Seel Ritchie  and
Emily Loving Aaronson Open the ORCID record for Emily Loving Aaronson [Opens in a new window]
Alexa Gips*
Affiliation:
Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO Department of Medicine, University of Colorado School of Medicine, Denver, CO
Bethany-Rose Daubman
Affiliation:
Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Laura A. Petrillo
Affiliation:
Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Jason Bowman
Affiliation:
Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Kei Ouchi
Affiliation:
Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
Lara Traeger
Affiliation:
Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
Vicki Jackson
Affiliation:
Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Corita Grudzen
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, Department of Population Health, NYU Grossman School of Medicine, New York, NY
Christine Seel Ritchie
Affiliation:
Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA Mongan Institute, Massachusetts General Hospital, Boston, MA
Emily Loving Aaronson
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians’ Organization, Boston, MA
*
Author for correspondence: Alexa Gips, Department of Emergency Medicine, University of Colorado, School of Medicine Campus Box B‐21512401 East 17th Avenue, Aurora, CO 80045. E-mail: [email protected]
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Abstract

Objective

To describe the perceived qualities of successful palliative care (PC) providers in the emergency department (ED), barriers and facilitators to ED–PC, and clinicians’ perspectives on the future of ED–PC.

Method

This qualitative study using semi-structured interviews was conducted in June–August 2020. Interviews were analyzed via a two-phase Rapid Analysis. The study's primary outcomes (innovations in ED–PC during COVID) are published elsewhere. In this secondary analysis, we examine interviewee responses to broader questions about ED–PC currently and in the future.

Results

PC providers perceived as successful in their work in the ED were described as autonomous, competent, flexible, fast, and fluent in ED language and culture. Barriers to ED–PC integration included the ED environment, lack of access to PC providers at all times, the ED perception of PC, and the lack of a supporting financial model. Facilitators to ED–PC integration included proactive identification of patients who would benefit from PC, ED-focused PC education and tools, PC presence in the ED, and data supporting ED–PC. Increased primary PC education for ED staff, increased automation, and innovative ED–PC models were seen as areas for future growth.

Significance of results

Our findings provide useful information for PC programs considering expanding their ED presence, particularly as this is the first study to our knowledge that examines traits of successful PC providers in the ED environment. Our findings also suggest that, despite growth in the arena of ED–PC, barriers and facilitators remain similar to those identified previously. Future research is needed to evaluate the impact that ED–PC initiatives may have on patient and system outcomes, to identify a financial model to maintain ED–PC integration, and to examine whether perceptions of successful providers align with objective measures of the same.

Keywords

Emergency departmentEmergency medicinePalliative careQualitative
Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 3 , June 2022 , pp. 363 - 368
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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