Chalfin Brandon, Salazar Spencer M, Laico Regina, Hughes Susan, Macmillan Patrick J
University of California San Francisco Fresno, Department of Emergency Medicine, Fresno, California.
University of California San Francisco Fresno, Department of Hospice and Palliative Medicine, Fresno, California.
West J Emerg Med. 2025 Jul 11;26(4):1040-1046. doi: 10.5811/westjem.35388.
Palliative care consultation teams provide significant advantages for patients, healthcare professionals, and hospitals, particularly in pain management, family support, and clinician satisfaction. Numerous studies show that inpatient palliative care services yield benefits regardless of the timing of initiation, contributing to shortened hospital stays and cost savings. Recent studies have focused on the timing and setting of palliative care, especially in emergency departments (ED), highlighting improved patient outcomes when initiated early. This study explores the potential of embedding hybrid physicians (double-boarded physicians in palliative and emergency medicine) in the ED to further enhance patient care and reduce hospital resources.
This small pilot case-control study included a subset of all patients referred by emergency physicians and hospitalists for palliative care within 24 hours of registration, physically present in the ED. Cases consisted of all the patients seen by hybrid physicians embedded in the ED. Matched controls were seen by palliative care-boarded clinicians (various other primary specialties) during palliative care rounds in the hospital. Matches were based on diagnosis, comorbidities, and referral date. Outcomes measured included hospital length of stay, total charges, discharge disposition, code status changes, and ED visits not resulting in admission. Statistical analyses used chi-square tests for categorical data and Wilcoxon rank-sum test for continuous data.
In a four-year period, 68 cases were attended by hybrid physicians over 57 disparate days. These cases had significantly shorter hospital stays (median 2.1 days) compared to controls (6.5 days, P<.001). Total charges were also lower for cases ($37,800) than for controls ($78,000, P<.001). A notable secondary outcome was that 26.5% of ED visits in the case group did not result in hospital admission, compared to all controls being admitted (P<.001). In addition, more cases than controls had a code status of comfort care at discharge (P=.07) CONCLUSION: Embedding hybrid physicians in the ED significantly shortened hospital stays and reduced charges for seriously ill patients. These findings support the further exploration of integrating such physicians into ED settings to enhance patient care and optimize hospital resources.
姑息治疗咨询团队为患者、医护人员和医院带来了显著优势，尤其是在疼痛管理、家庭支持和临床医生满意度方面。大量研究表明，住院姑息治疗服务无论启动时间如何都能带来益处，有助于缩短住院时间并节省成本。近期研究聚焦于姑息治疗的时机和环境，特别是在急诊科（ED），强调早期启动时患者预后会得到改善。本研究探讨在急诊科嵌入混合型医生（同时具备姑息医学和急诊医学双重资质的医生）以进一步提升患者护理并减少医院资源的潜力。
这项小型试点病例对照研究纳入了急诊医生和住院医生在患者登记后24小时内转介至姑息治疗的所有患者中的一个子集，这些患者当时实际在急诊科。病例组包括急诊科嵌入的混合型医生诊治的所有患者。匹配的对照组是在医院姑息治疗查房期间由具有姑息治疗资质的临床医生（其他各种主要专科）诊治的患者。匹配基于诊断、合并症和转介日期。测量的结果包括住院时间、总费用、出院处置、代码状态变化以及未导致住院的急诊就诊情况。统计分析对分类数据使用卡方检验，对连续数据使用威尔科克森秩和检验。
在四年期间，混合型医生在不同的57天里诊治了68例病例。与对照组（6.5天）相比，这些病例的住院时间显著更短（中位数2.1天，P<.001）。病例组的总费用（37,800美元）也低于对照组（78,000美元，P<.001）。一个值得注意的次要结果是，病例组中26.补5%的急诊就诊未导致住院，而对照组所有患者均住院（P<.001）。此外，出院时处于舒适护理代码状态的病例比对照组更多（P=.07）。结论：在急诊科嵌入混合型医生显著缩短了重症患者的住院时间并降低了费用。这些发现支持进一步探索将此类医生整合到急诊科环境中，以提升患者护理并优化医院资源。
