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Featured Reviews in Palliative Care and Emergency Medicine:

United States Best Practice Guidelines for Primary Palliative Care in the Emergency Department.

By Dr. Justin K. Brooten, MD
Editor-in-Chief, PalliEM.org

It is incredibly exciting for me to see the number of colleagues in Emergency Medicine and Palliative Care who have developed a passion for integration in these two fields.  In addition, there are many academic physicians who are collaborating to develop the resources to help move this field forward.  To further their efforts I am hoping to highlight some of the work being done which contributes to the growing body of resources in palliative care and emergency medicine integration.

Summary

Loffredo et al highlight the key role that emergency departments (EDs) play in providing palliative care (PC) as well as the issues which arise from the heterogeneity of resources and the high variability in how palliative care is provided in some cases.  They describe the supporting basis for why palliative care is an essential component to providing quality patient and family-centered care as well as the need for standardized guidelines to ensure that EDs are adequately prepared to care for these patients.  They describe their process for culminating best practices from the literature and provide summary tables of key aspects of providing ED palliative care.

Key Takeaways

  • A heterogeneous body of literature exists which describes aspects of PC /emergency medicine (EM) integration
  • Standard practice guidelines are necessary to avoid unintended harms and to ensure that key aspects of ED palliative care are addressed
  • EDs need to employ tiered and comprehensive methods for palliative care screening
  • Primary palliative care can occur simultaneously with life extending therapies
  • Acute symptoms need to be appropriately addressed
  • Palliative care specialist involvement in the ED should be encouraged
  • Goals of care discussions should be structured to elicit essential aspects of care goals and medical decision making
  • Standard processes need to be in place for comfort care provision and hospice care transitions

What I Like About this Article

  • Very comprehensive review which highlights key aspects of palliative care integration into the ED
  • Detailed explanation of palliative care screening
  • Tables provided for general guidance on symptom management
  • General information provided on systematic goals of care discussions

Next Steps
As a review, this is a springboard to driving into deeper detail on each of these topics but this article provides an excellent overview of key principles to consider when implementing a comprehensive plan for ED palliative care integration.


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