Emergency Departments as the Portal of Entry for Inpatient Geriatric Hospice and Palliative Medicine Consults

Outcomes 1. Recognize the Emergency Department as a primary portal of hospital entry for downstream Hospice and Palliative Medicine Consults in Geriatric patients.2. Recognize that one out of eleven geriatric ED patients in this sample received a Hospice and/or Palliative medicine consult during their hospitalization. Key Message At the crossroads of acute care and palliative medicine, Emergency Departments (ED) play a defining role in providing end-of-life geriatric care. This study specifically explores geriatric ED visits and subsequent Hospice and Palliative Medicine (HPM) needs, uncovering a rising annual trend of HPM consults and identifying the ED as the portal of hospital entry for 84.4% of all these patients. Introduction At the crossroads of acute care and palliative medicine, Emergency Departments (ED) play a defining role in providing end-of-life geriatric care. Objective This study aims to quantify the prevalence and trends of geriatric (Age > 65) ED visits and subsequent downstream hospice and palliative medicine (HPM) needs. Methods We conducted a multi-center retrospective cohort study of electronic health records from five hospitals within a large metropolitan health system, from January 1st, 2018, to December 31st, 2022. Data included all ED visits and inpatient hospital admissions in adult patients with a HPM consult ordered during their encounter. A variety of patient specific demographic, clinical, and outcome variables were collected. The yearly number of HPM consults ordered in each hospital were also obtained and compared by year and site. Across years, we compared the incidence of geriatric ED visits, hospitalizations and HPM consults per every 1,000 geriatric ED visits. Data analysis included descriptive statistics, chi-square testing, and regression analysis. Results A total of 27,100 HPM consults were ordered for 23,555 unique patients meeting inclusion criteria. In 2018, 4,229 unique patients received HPM consults, and this number grew by 24.1% to 5,247 consults in 2022 (p <.001). Among patients who received HPM consults, 84.4% (19,870) were admitted to the hospital through the ED. Of all HPM consults, 74.8% (17,622) involved geriatric patients. Geriatric patients accounted for 23.2% (503,249) of all ED encounters, of which 42.3% (231,036) resulted in an inpatient hospitalization or observation stay. Of these geriatric admissions, 7.8% (16,698) ultimately received a HPM consult. The calculated prevalence of HPM consults for geriatric patients was 33 downstream consults for every 1,000 geriatric ED visits. Keywords Emergencies / Refractory Symptom ManagementScientific Research