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0920 0945 shreves

As our population ages, the complexity of patients seeking care in the emergency department will increase dramatically. Chronic and terminal diseases will be ever-present but increasingly in patients also negotiating challenges like functional and cognitive decline. While their needs are different, in many hospitals, it is business as usual. A highly skilled and well-intentioned staff stands ready to deploy a limitless supply of diagnostic and therapeutic options designed to help patients live longer, not necessarily better.

Relying on default pathways that prioritize life-prolongation at the mercy of comfort and dignity has already left many patients and doctors feeling unsatisfied, while wasting precious healthcare resources. The future should not be more of the same.

If a new and better clinical road is to be paved in the future, it will be with the aid of palliative care, a specialty, philosophy and movement in medicine. Getting patients better access to palliative care should be a priority for our specialty. For some, this will mean partnering with existing palliative care specialists and hospices. Unfortunately, for most of us, the palliative care workforce will never be able to match the increasing demand created by our patients. This means that we must all do the hard, but incredibly rewarding work of learning a basic palliative care skillset. No pressure but the future of healthcare depends on it!

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0920 0945 shreves

  1. 1. We Need Palliative Care Everywhere SMACC DUB 2016 Ashley Shreves, MD Dept of Emergency Medicine Ochsner Medical Center New Orleans, LA
  2. 2. Case • 2009 • EMS: 93 y/o f, resp distress • HR 25, BP 90/50, O2 sat 90%, RR 35
  3. 3. What happened next...
  4. 4. Specific challenges • Identify dying trajectory • Capacity assessment • Advance directives • Difficult communication • Withholding/withdrawing LST • EOL symptom management • Spiritual competency • Ethics • Systems of care
  5. 5. Maybe it’s just me
  6. 6. Conversations bad, brief or nonexistant Dying patients “neglected;” staff uncomfortable Dying in hospital: less respect, quality of care worse
  8. 8. Relevant to you? Canada: 1/3 cancer patients visit ED last 2 wks of life Australia: 65% patients w serious illness die in hospital/ED
  10. 10. WHAT SHOULD WE DO?
  11. 11. Consult Palliative Care? • Sure, but… • 67% US hospitals (50+ beds) have pal care • Workforce shortage: have 3K, need 18K (just in hospital) • There will never be enough Lupe D et al. J Pain Symptom Manage 2010 Dumanovsky T et al. J Palliate Med 2016 Kamal AH et al. Ann Intern Med 2015
  12. 12. Solution?
  13. 13. Fellowship
  14. 14. Mid-career courses
  15. 15. Online resources
  16. 16. We need palliative care everywhere