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Preliminary Report of a Palliative Care and Case Management Project in an Emergency Department for Chronically Ill Elderly Patients

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Abstract

The Palliative Care Service at Montefiore Medical Center (MMC) established a pilot project in the emergency department (ED) to identify chronically ill older adults in need of palliative care, homecare, and hospice services and to link such patients with these services. Two advance practice nurses conducted consultations on elderly patients who were found to have one or more “palliative care triggers” on initial screening. A standardized medical record abstraction form was developed. Service utilization and survival were evaluated using the Clinical Information Systems of MMC. Activity of daily living items were developed from the Outcome and Assessment Information Set and the Palliative Care Performance Scale (PPS). Risk factors for hospitalization and use of the ED were taken from the SIGNET model risk screening tool. Physical and emotional symptoms were evaluated using the 28-item Memorial Symptom Assessment Scale short form. Preliminary outcomes and characteristics are presented for 291 patients who completed the intake needs assessment questionnaire. Almost one third (30.9%) of the study cohort died during the project period. Most of the deaths occurred beyond the medical center (7.7% died in the medical center and 23.3% outside the medical center). Thirty percent of patients who died were enrolled on a hospice. Survival time was predicted by the presence of dyspnea, clinician prediction of death on the current hospitalization, psychosocial distress, and PPS scores. Chronically ill patients visiting an urban community ED had complex medical and psychosocial problems with limited support systems and homecare services. Significant proportions of such patients can be expected to have limited likelihood of survival. The presence of palliative homecare and hospice outreach services in the ED in urban community hospitals may provide an effective strategy for linkage of elderly patients at the end of life with otherwise underutilized services.

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Authors and Affiliations

  1. Palliative Care Service, Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3335 Steuben Avenue, Bronx, NY, 10467, USA

    Sean O’ Mahony, Janice Simpson, Bernadette Huvane, Marlene McHugh, Allen Hutcheson, Serife Karakas & Philip Higgins

  2. Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA

    Arthur Blank & Peter Selwyn

  3. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Judy Persaud

  4. Emergency Department, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA

    Susan McAllen & Michelle Davitt

Authors
  1. Sean O’ Mahony
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  2. Arthur Blank
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  3. Janice Simpson
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  4. Judy Persaud
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  5. Bernadette Huvane
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  6. Susan McAllen
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  7. Michelle Davitt
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  8. Marlene McHugh
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  9. Allen Hutcheson
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  10. Serife Karakas
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  11. Philip Higgins
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  12. Peter Selwyn
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Corresponding author

Correspondence to Sean O’ Mahony.

Additional information

O’ Mahony, Simpson, Huvane, McHugh, Hutcheson, Karakas, and Higgins are with the Palliative Care Service, Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Blank and Selwyn are with the Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA; Persaud is with the Memorial Sloan Kettering Cancer Center, New York, NY, USA; McAllen and Davitt are with the Emergency Department, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.

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Mahony, S., Blank, A., Simpson, J. et al. Preliminary Report of a Palliative Care and Case Management Project in an Emergency Department for Chronically Ill Elderly Patients. J Urban Health 85, 443–451 (2008). https://doi.org/10.1007/s11524-008-9257-z

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  • DOI: https://doi.org/10.1007/s11524-008-9257-z

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