- Most severely and chronically ill patients enter hospitals through the ED.
- ED is always open. To everyone.
- Approximately 400,000 deaths occur in EDs in the U.S. annually.
- When there are abrupt changes in a patient’s condition or new distressing symptoms appear, patients go to the ED.
- The ED is where goals of care for that episode are determined:
- Intensity and trajectory of care plan is set.
- Admission decisions are made by ED staff (often to ICU).
- Physicians and staff have opportunity for discussions with patients and families. Many patients do not have pre-established end-of-life care goals.
Perspective of an ED Physician:
“The emergency department is a bottleneck and a staging area- a place of transition for many patients, whether from one health plan to another or one stage of life to another. It’s a place of crisis and opportunity- where changes in treatment philosophy are easier to implement.”
Dr. Knox Todd, Beth Israel Medical Center NYC, Center to Advance Palliative Care, Audio Conference, January 11, 2007