The Compassion & Choices National Emergency and Palliative Medicine Initiative (NEPMI) strives to transform care by advancing and promoting the integration of palliative care in emergency settings.
Our NEPMI brings together clinicians from across the country to build awareness, collect best practices in the field and identify opportunities to build collaborations. The initiative focuses on improving patient-centered care for people with life-threatening and life-limiting illness. Ongoing efforts will focus on expanding research and data collection and promoting new and existing programs.
Adults aged 65 and older have the highest ED utilization compared to any other age group.
50% of older adults will visit the ED in the last month of their life.
10,000,000 adults aged 75 and older visit the ED yearly.
Because emergency health conditions affect individuals of all racial, gender, ethnic, socio-economic and religious backgrounds, the initiative seeks to address long-standing inequities in end-of-life care. One example is the lower-than-average adoption of hospice services by historically marginalized communities.
The expert and rapid care provided in emergency departments can be what many people who visit need, for some, it can even be life-saving. However, for adults living with serious and terminal health conditions, aggressive treatment and invasive interventions may not be beneficial or what they want.
Research has shown people with serious illnesses who visit the ED can expect:
- Poorly treated pain and other symptoms.
- Little support for the needs of family members
- Inadequate communication about disease prognosis and goals of care.
The integration of palliative care in emergency medicine recognizes the unique opportunity to clarify goals of care during a critical time rather than defaulting to aggressive measures. It focuses on the values, concerns, wants and needs of the individual.
Research has shown integrating palliative care into emergency care improves quality of care, reduces hospitalization, reduces unnecessary costs and best of all, improves patient satisfaction and gives patients a sense of control in their care.
- Providing care and support for people living with serious illness.
- Focusing on pain and symptom management, relief of physical, psychological, spiritual suffering.
- Addressing the patient’s goals, desires and decisions first.
- Improving quality of life and overall well-being.
- Complementing other care and treatments.
- Reducing unnecessary hospital visits.
If the ED is to continue to be the primary portal of hospital entry for patients requiring emergent care for acute and chronic terminal illnesses, then it should also be equally prepared to provide the earliest access to palliative care and advance care planning resources for patients and families who may want and benefit from these services
-Satheesh Gunaga, DO
Vice Chair of Emergency Medicine, ED Research Director
Henry Ford Wyandotte Hospital
The Importance of Adoption and Replication
Although an increasing number of professional society guidelines recommend early palliative involvement, including the American Academy of Emergency Medicine, American College of Emergency
Physicians 2013 Choosing Wisely Campaign, American Society of Clinical Oncology 2018 Guideline Updates, National Comprehensive Cancer Network 2009, American Thoracic Society 2008 Clinical Policy Statement, it remains an option not widely available
throughout the United States.
Compassion & Choices through the National Emergency and Palliative Medicine Initiative seeks to raise awareness of the current programs and benefits of the service on a national scale and help healthcare systems replicate and improve successful programs that integrate palliative support in the emergency care settings.
