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Embedding Palliative Consultants in the Emergency Departmet Creates Significant Value for Healthcare Systems
Annals of Emergency Medicine ; 78(4):S49-S50, 2021.
Article in English | EMBASE | ID: covidwho-1748272
ABSTRACT
Study

Objective:

A vast majority of patients with serious illness present to emergency departments (EDs) in their last year of life with unmet palliative needs. ED-requested palliative care (PC) consults have been shown to reduce hospital length-of-stay and costs. As integrated care delivery models evolve, many health systems are considering how to best deploy PC resources and protocols to the ED to facilitate earlier engagement. Our objective was to demonstrate the financial and operational viability of embedding a palliative consultant in the ED.

Methods:

This single-site hospital with 42,000 annual ED visits featured a mature PC team, with historically high ICU/ward but minimal ED engagement. Institutional alignment was acquired from key stakeholders (ED, PC, ICU, hospitalists, administration) to fund a new ED-embedded PC consult service. A single PC physician or nurse practitioner was co-located in the ED fishbowl between the hours of 11am-7pm daily, initially weekdays and expanded to weekends after 10 weeks. ED consults were both proactively identified by PC and actively requested by ED clinicians. Clinical and financial data from 08/2020-04/2021 were tracked through the electronic health record, Palliative Care Quality Network registry, and McKesson Horizon Performance Manager.

Results:

Over 8.5 months, the ED-embedded PC service saw 565 consults. Of these, 46% had a code status change, 8% admitted to a lower level of care, 9% avoided hospitalization, and 13% newly referred to hospice. ED consult volume was consistent month-over-month. ED length-of-stay did not appreciably lengthen. None of these cases were related to COVID-19. Importantly, this additional consult team did not cannibalize inpatient consult volume from usual practice. Compared to inpatient PC consults, median hospital length-of-stay decreased from 10.8 days to 3.3 days (p<0.001). Likewise, median direct costs per hospitalization decreased from $17,726 to $4,617, a 75% reduction or $13,019 per hospitalization (p<0.001). Annualized direct cost avoidance will be $6.5M. Subsequently, the ED provider group volunteered to include ED-palliative consults as a performance metric in their compensation model.

Conclusions:

ED-embedded palliative consultants are a high cost but even higher-reward intervention. For this hospital, return on investment will exceed 15x. True impact is likely even greater given analyses were not compared against all-comers, and did not account for future deferral of ED revisits and healthcare utilization from earlier introduction into outpatient palliative and hospice services. ED-palliative partnerships significantly advance the quadruple aim and position the ED to lead change in healthcare systems which increasingly prioritize value-based care.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Annals of Emergency Medicine Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Annals of Emergency Medicine Year: 2021 Document Type: Article