This document discusses the integration of palliative care into emergency medicine. It begins with definitions of palliative care and notes the aging global population and increasing chronic illnesses. Palliative care aims to improve quality of life for those with life-threatening illnesses through comprehensive symptom and psychosocial support. However, emergency departments traditionally take a symptom-focused approach, creating challenges for integrating palliative care principles. The document then outlines screening tools, common symptoms, reasons for emergency visits, and the need for emergency physician training in palliative care. It presents models for integrating palliative care and emergency medicine and concludes that institutions should develop customized approaches based on available resources and staff training needs.

1. The Palliative Care Integration into the
Emergency Medicine
Dr.Nurşah Başol
Gaziosmanpasa University, Faculty of Medicine,
Department of Emergency Medicine
Tokat, TURKEY
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2. Definition and Main Features of Palliative Care
Screening Tools
Symptoms
Reasons
Training
Integration Models
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3. Introduction
Two billion older people by 2050
Growth rate 2.6%
United Nations Department of Economic and Social
Affairs. World population ageing. New York: United
Nations, 2013.
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4. Aging population Development in medical care
Growing number of people living with chronic life-
limiting illnesses.
Increased use of Emergency Department (ED) and
hospitalization
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5. 19 million people who had palliative care needs,
69% aged 60 years and above.
World Health Organization and Worldwide Palliative Care Alliance.
Global atlas of palliative care at the end of life. London: Worldwide
Palliative Care Alliance, 2014.
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6. 6

7. Palliative Care
Why? Better quality of life
Who? People with life-threatining illness and
families
When? After diagnosis of illness
How? Assessment and management of pain, other
physical problems, psychosocial issues and spiritual
needs
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8. Palliative Care
Patient centered care
Not necessary to draw immediate medical actions
Less invasiveness in critical situations
Dying is an expected outcome
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10. Emergency Medicine
Symptom oriented approach
Find the problem
Solve it as soon as possible
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11. Emergency Department
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Screening Tools

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• Symptoms

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21. Reasons
Serious uncontrolled symptoms
Simple interventions
Emotional distress
Fear of death process
Problems about family/caregivers
Lack of understanding avoidable
health care facilities
Lowery D, Quest T. Emergency Medicine and Palliative Care. Clin
Geriatric Med 31(2015) 295-303.
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22. Training
Assessment of illness trajectory
Determination of prognosis, communicate bad news
Interpretation and formation of an advance care plan
Symptom management (both pain and nonpain)
Withdrawal and withholding of life-sustaining
treatments
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23. Training
Management of imminently dying patients
Identify and implement hospice and palliative care
referrals and care plans
Understanding of ethical and legal issues
Display spiritual and cultural competency
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Avoidable ED Visits

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28. Institutional and Community
Resources
 In-house palliative care team/unit availability and
call schedules
Outpatient clinic availability and practice hours
Community hospice providers
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29. 24/7 Chaplaincy support
24/7 Social service support
Bereavement support
Ethics consultant
Child life specialist support availability
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Institutional and Community
Resources

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Early PC consultation in the ED
impacts
Quality of life
Health care utilization
Survival

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Integration Models

35. Increased patient and family satisfaction
Reduction on costs
Decreased LOS
Reduction on the intensity of care
Reduction in resuscitation rates
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36. Traditional consultation model
Basic integration model
Advanced integration model
ED-focused advanced integration model
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Integration Models

37. Traditional Consultation Model
No collaborative relationship to help integrate PC
principles into the ED care.
Basic Integration Model
Formal working relationship between PC and ED
Mutual understanding of the processes and function
Agreed programmatic goals
PC training for ED Staff
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38. Advanced Integration Model
Protocols to identify patients
Specific criteria for seeking a PC consultation
PC-focused assessment and documentation tools,
communication encounters and transitions of care
ED-focused Advanced Integration Model
One or more EM/palliative care dual-certified
physicians
Case management of high-risk PC populations
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Solutions
Employing an ambulatory care model
Using direct admission procedures
Designating special ward and ED areas for
such patients
Better education about PC

40. Benefits of PC
Significant improvements in patient quality of life
and mood
Increased patient and caregiver satisfaction
Decreased ICU days, LOS, physical symptoms
Improved resource usage
Reduction in health care costs
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41. Create Your Own Way
Institution-specific needs
Availability of local resources
Ability of an existing PC program or hospice
Local ED clinician culture
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42. Create Your Own Way
Training of ED Staff
Identification
Needs Assesment
Symptom Management
Referraling
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43. ‘You matter because you are you. You matter to
the last moment of your life, and we will do all we
can , not only to help you die peacefully, but also
to live until you die.’
Cicely Saunders (1918-2005) ‘The founder of modern hospice movement’
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44. Thank you! 44