Table 2.
Summary of Innovations in PC-ED
| Type of Innovation | Example of Innovation | Innovation Detail |
|---|---|---|
| Model of care delivery | Embedded PC clinician in the ED | PC clinician seated in the ED dedicated only to ED consults |
| Strengthened ED presence | Achieved through daily rounding and EMR chat function | |
| Mobile PC consult service | Dedicated service focused on ED and ICU needs | |
| Staffing | PC attendings with extenders | Residents with focused GOC or ACP training |
| PC attending with PC fellows | Triage cases based on complexity to appropriate clinician | |
| PC extender with psychosocial partner | Pair volunteer non-PC physician with social worker or child life specialist who perform all consults together | |
| Technology-enhanced PC-ED | Off-site tele PC | Centralized team of either RNs or PC physicians for all hospitals in a health system |
| Blended on-site tele PC | Triage patients based on their capacity to engage to either in person or tele PC | |
| Primary PC training and education | Trainings and tools | COVID-specific conversation training; collated resources (with apps, Google Docs, and provided laminated cards) |
| Case identification and task stratification | Proactive case identification | Remotely screen ED track board, daily rounding |
| Formal triggers (for primary PC or specialty consult) | Automated or manual—encompassing age, marker of underlying illness, marker of acute illness | |
| Focused abbreviated consults | Task-oriented consults focused on specific patient needs | |
| Nursing-initiated consults | Consults to PC triggered by nursing staff using clear trigger criteria |
PC = palliative care; ED = emergency department; EMR = electronic medical record; ICU = intensive care unit; GOC = goals of care; ACP = advanced care planning; RNs = registered nurses.