Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Am J Emerg Med. 2021 Dec;50:773-777. doi: 10.1016/j.ajem.2021.09.075. Epub 2021 Oct 1.
While the role of palliative care in the emergency department is recognized, barriers against the effective integration of palliative interventions and emergency care remain. We examined the association between goals-of-care and palliative care consultations and healthcare utilization outcomes in older adult patients who presented to the emergency department (ED) with sepsis.
We performed a retrospective review of 197 patients aged 65 years and older who presented to the ED with sepsis or septic shock. Healthcare utilization outcomes were compared between patients divided into 3 groups: no palliative care consultation, palliative care consultation within 4 days of admission (i.e., early consultation), and palliative care consultation after 4 days of admission (i.e., late consultation).
51% of patients did not receive any palliative consultation, 39% of patients underwent an early palliative care consultation (within 4 days), and 10% of patients underwent a late palliative care consultation (after 4 days). Patients who received late palliative care consultation had a significantly increased number of procedures, total length of stay, ICU length of stay, and cost (p < .01, p < .001, p < .05, p < .001; respectively). Regarding early palliative care consultation, there were no statistically significant associations between this intervention and our outcomes of interest; however, we noted a trend towards decreased total length of stay and decreased healthcare cost.
In patients aged 65 years and older who presented to the ED with sepsis, early palliative consultations were associated with reduced healthcare utilization as compared to late palliative consultations.
虽然姑息治疗在急诊科的作用已得到认可，但在将姑息干预措施与急诊护理有效整合方面仍存在障碍。我们研究了老年患者因败血症就诊于急诊科时，目标治疗与姑息治疗咨询和医疗保健利用结果之间的关系。
我们对 197 名年龄在 65 岁及以上的因败血症或感染性休克就诊于急诊科的患者进行了回顾性研究。将患者分为三组：未进行姑息治疗咨询组、入院后 4 天内（即早期咨询）进行姑息治疗咨询组和入院后 4 天以上（即晚期咨询）进行姑息治疗咨询组，比较三组患者的医疗保健利用结果。
51%的患者未进行任何姑息治疗咨询，39%的患者进行了早期姑息治疗咨询（在 4 天内），10%的患者进行了晚期姑息治疗咨询（在 4 天以上）。接受晚期姑息治疗咨询的患者进行了更多的检查，总住院时间、重症监护病房住院时间和医疗费用均显著增加（p <.01，p <.001，p <.05，p <.001；分别）。关于早期姑息治疗咨询，虽然该干预与我们感兴趣的结果之间没有统计学上的显著关联，但我们注意到总住院时间和医疗费用呈下降趋势。
在因败血症就诊于急诊科的 65 岁及以上的老年患者中，与晚期姑息治疗咨询相比，早期姑息治疗咨询与降低医疗保健利用率相关。
