Written by Jacob Altholz
Spoon Feed
Comprehensive palliative care training for emergency department clinicians and nurses did not have an effect on admission rates, subsequent visits, or 6-month mortality.
Palliative care by the ED – do patients live longer?
Palliative care delivered by specialists has numerous benefits, including higher patient satisfaction, overall symptom improvement, and even cost savings during admissions. This study evaluated if emergency departments that comprehensively train physicians, physician assistants, nurse practitioners, and nurses have a measurable effect on rate of admission and subsequent visits as well as 6-month mortality. Emergency departments received comprehensive trainings in addition to clinical support tools/audits and feedback with randomization in their training dates. Rates of admission, repeat visits, and mortality were tracked over six months in patients that were over 66 years old, had a Gagne comorbidity score over 6, and were “community-dwelling” (e.g. no use of hospice in the last year). Statistical analyses focused on pre- and post-intervention periods. Notably this study spanned the COVID pandemic, and certain time periods were excluded or corrected for using covariate analysis. No difference was found between pre- and post-intervention phases with odds ratios of very nearly one for rates of admission, admission to ICUs, repeat ED visits, readmission, home health use, hospice use, and mortality. Stepped-wedge trials are vulnerable to external factors and that it’s almost impossible to control for all factors. The pandemic makes it difficult to know if certain behaviors (repeat ED visits, for example) would have changed regardless. Notably, this study does not evaluate many of the conventionally-communicated benefits of palliative care such as patient satisfaction, symptom improvement etc.
How does this change my practice?
Given that the purpose of palliative care is explicitly patient comfort, I’m not particularly surprised by the results. If the study had shown that patients were no more satisfied or had no improvement in symptoms or quality of life, I would be more concerned about the utility in such training, but as it stands this does not really change my belief that a palliative approach should be considered in all eligible patients.
Source
Palliative Care Initiated in the Emergency Department: A Cluster Randomized Clinical Trial. JAMA. 2025 Jan 15. doi: 10.1001/jama.2024.23696. Epub ahead of print. PMID: 39813042
