Table 9.
The quality metrics that can be widely applied at the emergency department
| Patient Identification and Assessment for Palliative Care Needs | Management of Palliative Care in ED | Transitions of Care |
|---|---|---|
| Clinical outcomes | ||
| • Percentage of ED patients screened positive for palliative care eligibility (total and by using each screening tool) 1. Surprise question: not surprised if the patient died during this admission 2. Clinical indicators for example, frequent admission with the same problem 3. Specific disease indicators • Percentage of patients with X diagnosis who were screened positive for palliative care eligibility • Percentage of documented screening for palliative care eligibility in the target population (eg, X diagnosis, transfer from the long-term care facility) • Percentage of patients measured for psychospiritual social needs • Percentage of family members screened for caregiver strain |
• Percentage of patients with overall/each distressing symptom assessment documented • Time from symptom assessment to delivery of medication for symptom relief • Percentage of patients prescribed distressing symptom control medications in ED • Percentage of documented health proxy or decision maker in medical records in target population • Percentage of patients with do not attempt resuscitation status in target population • Percentage with documentation of advance directives/POLST/MOLST in target population • Percentage of patients who died within 24/48/72 h of ED admission with documented health proxy or decision maker in medical record |
• Percentage of X intervention after ED palliative care consultation • Percentage of deaths in the ICU and/or ED after ED palliative care consultation • Percentage of repeat ED visits (and/or readmission to the hospital) within 30 d • Percentage discharged to home after ED palliative care consultation • Percentage discharged to hospice care after ED palliative care consultation |
| Operational process | ||
| • Time from ED arrival to completion of palliative care screening • Percentage of personnel who completing the screening tool • Percentage of patients transfer from the long-term care facility • Percentage of patients who screened positive for palliative care eligibility and multiple ED visits (or hospitalizations) in X time |
• Percentage of X order sets placed by an ED clinician in target population • Percentage of palliative care order sets used in target population • Percentage of order sets used in ED patients with X condition • Percentage of intensive care in ED (and/or in this admission) in target population (eg, ventilator use, pressor support) |
• Percentage of ED referrals for palliative care consultation/hospice care • Percentage of patients admitted (total, ICU, non-ICU, palliative care unit) after palliative care consultation • Time from consult to response by palliative care team or hospice staff • ED length of stay for patients with palliative care consult (and/or in target population) vs ED length of stay for all patients, all discharged patients, all admitted patients • Hospital length of stay for patients with ED palliative care consultations (and/or in target population) • Percentage of canceled palliative care consultations by admitting clinician • Time from ED request for palliative care/hospice consultation to final disposition |
| Patient and/or family member satisfaction | ||
| • Satisfaction scores on patients who screened positive for palliative care eligibility | • Percentage of patients and/or family members reporting a high level of shared decision making with ED clinicians (eg, ED clinicians listen carefully, explain things in a way that was easy to understand) • Percentage of patients and/or family members reporting high level of satisfaction in end-of-life care for an ED patient death • Percentage of patients and/or family members highly satisfied with pain or symptom management in the ED |
• Percentage of patients and/or family members reporting high level of satisfaction with health care team communication • Percentage of patients and/or family members reporting high level of satisfaction in end-of-life care after palliative care consultation in the ED and a patient’s hospital death • Percentage of patients and/or family members reporting excellent coordination of care to the next health care setting from the ED |
Abbreviations: ED, emergency department; ICU, intensive care unit; MOLST/POLST, medical/physician’s/practitioner’s orders for life-sustaining treatment.
Data from [Goett R, Isaacs ED, Chan GK, et al. Quality measures for palliative care in the emergency department. Acad Emerg Med. 2022;10.1111/acem.14592. https://doi.org/10.1111/acem.14592] [George N, Phillips E, Zaurova M, Song C, Lamba S, Grudzen C. Palliative Care Screening and Assessment in the Emergency Department: A Systematic Review. J Pain Symptom Manage. 2016;51(1):108–19.e2. https://doi.org/10.1016/j.jpainsymman.2015.07.017].