Date of Award
Projects: SPU Access Only
Doctor of Nursing Practice (DNP)
Gloria Nam, PhD, ARNP, FNP-BC
Pam Davies, Ms, ARNP, A/GNP-C, ACHPN, RN-BC,FAANP
Improving Access to Palliative Care for Patients with Advanced Disease in the Emergency Department: Executive Summary
Introduction: Ninety million Americans are battling terminal and chronic illnesses that causes physical, psychosocial, spiritual, and financial suffering (Center to Advanced Palliative Care [CAPC], 2014; World Health Organization [WHO], 2018). The number of patients needing palliative care (PC) will double in the next 25 years, and Medicare spending to treat patients with multiple chronic illnesses is growing exponentially (CAPC, 2014). Palliative care can promote quality of life for these patients and their family members, yet many primary providers and staff in the emergency department (ED) fail to refer patients to PC due to time constraints, limited understanding of PC, and lack of standardized patient screening processes (Coventry, Grande, Richards & Todd, 2005; George et al., 2015).
The purpose of this project was to create sustainable approaches for a hospital’s ED to improve access to PC for patients with advanced diseases. This project explored the potentials and limitations of incorporating the evidence-based practice into the standard of the ED practice.
Methods: The project’s setting was a suburban hospital’s ED and targeted the staff. Current research guided this project design. The main intervention of the project consisted of implementing an evidence-based patient screening tool and creating an educational module to facilitate the use of the screening tool and the PC service. The project leader (PL) provided the educational module in a video format on a video sharing webpage. After the initial project implementation, in-person sessions were provided to encourage participation. The screening tool was adopted from a research by George et al. (2015) and shared with the ED staff for ten weeks. The PL collected the completed screening tools and delivered to the PC administrator weekly. This project was evaluated using the pre and post-survey data, the number of screened patients, and the reported number of PC consults from the PC administrator.
Results/Outcomes: Twenty-eight participants responded to the surveys. The project’s aim, to increase the number of PC consultations from the ED, was met. In a 10-week period, the ED staff identified a total of 11 patients who they met the criteria for the PC consults. Of the screened patients, two received consults from the PC administrator as a result of the screening tool. Although the rest of the screened patients still received the consults, they were seen as a result of the inpatient hospitalists’ request rather than the screening tool. The participants’ confidence level was increased from an average of 2.73 to 3.71 on a scale of five (Figure 1). All eight respondents of the post survey agreed that the screening tool was useful to identify PC eligible patients, but some suggested that integrating a reminder for the tool utilization into the hospital’s electronic medical record could increase the tool use.
The barriers for this project were the small number of screened patients, short implementation period resulted in the limited survey data, and lack of direct communication between the ED and PC teams. Although the ED team members completed the screening tool, a delay occurred between the completion of the screening tools and the delivery of the completed tools to the PC administrator. The completed screening tools were checked frequently to address the problem, but this approach was insufficient to minimize the delay in time.
Sustainability/Implications: This quality improvement project focused on integrating current research findings into the ED practice. Utilizing a screening tool and the educational module was feasible to implement in the ED setting. The screening tool can be implemented in other settings such as intensive care or oncology units. However, improving communication between the ED and PC teams would be ideal for a successful project in the future. A long-term project with larger sample size and data would be beneficial to confirm the project’s effectiveness. Incorporating the screening tool into the electronic medical record system may facilitate the use of the tool and staff participation in the future. Despite the limitations, this project showed the feasibility of increasing access to PC for patients with advanced diseases in the ED.
Cho, Jaekyung J., "Improving Access to Palliative Care for Patients with Advanced Disease in the Emergency Department" (2020). Doctor of Nursing Practice (DNP) Scholarly Projects. 8.