Abstract：
While increasing evidence shows that hospice and palliative care interventions in the ED can benefit patients and systems, little exists on the feasibility and effectiveness of identifying patients in the ED who might benefit from hospice care. Our aim was to evaluate the effect of a clinical care pathway on the identification of patients who would benefit from hospice in an academic medical center ED setting.
We instituted a clinical pathway for ED patients with potential need for or already enrolled in hospice. This pathway was digitally embedded in the electronic health record and made available to ED physicians, APPs and staff in a non-interruptive fashion. Patient and visit characteristics were evaluated for the six months before (05/04/2021-10/4/2021) and after (10/5/2021-05/04/2022) implementation.
After pathway implementation, more patients were identified as appropriate for hospice and ED length of stay (LOS) for qualifying patients decreased by a median of 2.9 h. Social work consultation for hospice evaluation increased, and more patients were discharged from the ED with hospice. As more patients were identified with end-of-life care needs, the number of patients admitted to the hospital increased. However, more patients were admitted under observation status, and admission LOS decreased by a median of 18.4 h.
This non-interruptive, digitally embedded clinical care pathway provided guidance for ED physicians and APPs to initiate hospice referrals. More patients received social work consultation and were identified as hospice eligible. Those patients admitted to the hospital had a decrease in both ED and hospital admission LOS.
We instituted a clinical pathway for ED patients with potential need for or already enrolled in hospice. This pathway was digitally embedded in the electronic health record and made available to ED physicians, APPs and staff in a non-interruptive fashion. Patient and visit characteristics were evaluated for the six months before (05/04/2021-10/4/2021) and after (10/5/2021-05/04/2022) implementation.
After pathway implementation, more patients were identified as appropriate for hospice and ED length of stay (LOS) for qualifying patients decreased by a median of 2.9 h. Social work consultation for hospice evaluation increased, and more patients were discharged from the ED with hospice. As more patients were identified with end-of-life care needs, the number of patients admitted to the hospital increased. However, more patients were admitted under observation status, and admission LOS decreased by a median of 18.4 h.
This non-interruptive, digitally embedded clinical care pathway provided guidance for ED physicians and APPs to initiate hospice referrals. More patients received social work consultation and were identified as hospice eligible. Those patients admitted to the hospital had a decrease in both ED and hospital admission LOS.
摘要：
背景：虽然越来越多的证据表明，急诊室的临终关怀和姑息治疗干预措施可以使患者和系统受益，在ED中确定可能从临终关怀中受益的患者的可行性和有效性几乎没有。我们的目的是评估临床护理路径对识别将在学术医疗中心ED环境中受益于临终关怀的患者的影响。
方法：我们为有可能需要或已经登记接受临终关怀的ED患者建立了临床路径。该途径以数字方式嵌入电子健康记录中，并提供给ED医生，APP和工作人员以不间断的方式。在实施前（2021年5月4日-2021年10月4日）和实施后（2021年10月5日-2022年05月04日）6个月评估患者和就诊特征。
结果：路径实施后，更多的患者被确定为适合临终关怀和ED住院时间（LOS）的合格患者减少了2.9小时的中位数。更多的患者因临终关怀而出院。随着越来越多的患者被确定有临终护理需求，入院的病人人数有所增加。然而,更多的患者在观察状态下入院，入院LOS中位数下降18.4小时。
结论：这种不间断的，数字化嵌入式临床护理路径为ED医师和APP启动临终关怀转诊提供了指导.更多的患者接受了社会工作咨询，并被确定为符合临终关怀条件。入院的患者ED和入院LOS均下降。
方法：我们为有可能需要或已经登记接受临终关怀的ED患者建立了临床路径。该途径以数字方式嵌入电子健康记录中，并提供给ED医生，APP和工作人员以不间断的方式。在实施前（2021年5月4日-2021年10月4日）和实施后（2021年10月5日-2022年05月04日）6个月评估患者和就诊特征。
结果：路径实施后，更多的患者被确定为适合临终关怀和ED住院时间（LOS）的合格患者减少了2.9小时的中位数。更多的患者因临终关怀而出院。随着越来越多的患者被确定有临终护理需求，入院的病人人数有所增加。然而,更多的患者在观察状态下入院，入院LOS中位数下降18.4小时。
结论：这种不间断的，数字化嵌入式临床护理路径为ED医师和APP启动临终关怀转诊提供了指导.更多的患者接受了社会工作咨询，并被确定为符合临终关怀条件。入院的患者ED和入院LOS均下降。
