Automated Identification of Patients with Advanced Illness.

Early identification of advanced illness patients within an inpatient population is essential in order to establish the patient's goals of care. Having goals of care conversations enables hospital patients to dictate a plan for care in concordance with their values and wishes. These conversations allow a patient to maintain some control, rather than be subjected to a default care process that may not be desired and may not provide benefit.

Remote Advance Care Planning in the Emergency Department During COVID-19 Disaster: Program Development and Initial Evaluation.

Background: The coronavirus disease 2019 pandemic caused an unprecedented surge of patients presenting to emergency departments and forced hospitals to adapt to provide care to patients safely and effectively. The purpose here was to disseminate a novel program developed under disaster conditions to address advance care planning communications.

Methods: A program development and initial evaluation was conducted for the Remote Goals of Care program, which was created for families to communicate patient goals of care and reduce responsibilities of those in the emergency department.

Respiratory Distress in Hospitalized Non-Mechanically Ventilated COVID-19 Adults: A Retrospective Multicenter Cohort Study.

Background: COVID-19 typically presents with respiratory symptoms which may progress with severe disease. There are standard guidelines for managing respiratory distress (e.g.

Dissemination of geriatric emergency department accreditation in a large health system.

The population of older adults in the United States is expanding rapidly. With this expansion, the healthcare system, and emergency departments (EDs) in particular, should provide geriatric-focused care tailored to the needs of this population. To this end, the American College of Emergency Physicians (ACEP) released a geriatric emergency department accreditation (GEDA) to certify EDs that have the staffing, training, and resources to provide high-quality, geriatric-focused, emergent care.

"Palliative Pandemic Plan," Triage and Symptoms Algorithm as a Strategy to Decrease Providers' Exposure, While Trying to Increase Teams Availability and Guidance for Goals of Care (GOC) and Symptoms Control.

As the spread of the novel coronavirus disease 2019 (COVID-19) continues worldwide, health care systems are facing increased demand with concurrent health care provider shortages. This increase in patient demand and potential for provider shortages is particularly apparent for palliative medicine, where there are already shortages in the provision of this care. In response to the developing pandemic, our Geriatrics and Palliative (GAP) Medicine team formulated a 2-team approach which includes triage algorithms for palliative consults as well as acute symptomatic management for both patients diagnosed with or under investigation (PUI) for COVID-19.

Knowledge, Attitudes, and Interactions with Chaplains and Nursing Staff Outcomes: A Survey Study.

We conducted a cross-sectional survey of nursing staff (n = 51) in an academic hospital finding a significant inverse relationship between the frequency of chaplaincy interaction and perceived stress (r = - 0.27, p = 0.05).

The GAP-ED Project: Improving Care for Elderly Patients Presenting to the Emergency Department.

Background: Older adults presenting to the emergency department (ED) represent a highly vulnerable patient population with complex conditions and multiple comorbidities. The introduction of a Geriatric and Palliative (GAP)-ED partnership may be an effective strategy to avoid unneeded admissions and improve outcomes for this population.

Objectives: The primary objective was to decrease 30-day revisit and hospitalization rates in this population through identifying patients that could be safely sent home with connection to community resources.

A Multicomponent Model to Improve Hospital Care of Older Adults with Cognitive Impairment: A Propensity Score-Matched Analysis.

Objectives: To determine whether a multicomponent intervention improves care in hospitalized older adults with cognitive impairment.

Design: One-year retrospective chart review with propensity score matching on critical demographic and clinical variables was used to compare individauls with cognitive impairmenet on intervention and nonintervention units.

Setting: Large tertiary medical center.

Identifying Advanced Illness Patients in the Emergency Department and Having Goals-of-Care Discussions to Assist with Early Hospice Referral.

Background: The emergency department (ED) is often where patients with advanced illness (AI) present when faced with an acute deterioration in their disease.

Objectives: To investigate the effectiveness of our AI Management program in the ED on key outcomes.

Methods: We conducted a pre-post study with a retrospective chart review with ED patients at an academic, tertiary care hospital in the New York metropolitan area.

Other Ways of Knowing.

Background: Patients with advanced-stage chronic obstructive pulmonary disease (COPD) may suffer severe respiratory exacerbations and need to decide between accepting life-sustaining treatments versus foregoing these treatments (choosing comfort care only). We designed the InformedTogether decision aid to inform this decision and describe results of a pilot study to assess usability focusing on participants' trust in the content of the decision aid, acceptability, recommendations for improvement, and emotional reactions to this emotionally laden decision.

Methods: Study participants ( N = 26) comprising clinicians, patients, and surrogates viewed the decision aid, completed usability tasks, and participated in interviews and focus groups assessing comprehension, trust, perception of bias, and perceived acceptability of InformedTogether.

Elder Orphans Hiding in Plain Sight: A Growing Vulnerable Population.

Adults are increasingly aging alone with multiple chronic diseases and are geographically distant from family or friends. It is challenging for clinicians to identify these individuals, often struggling with managing the growing difficulties and the complexities involved in delivering care to this population. Clinicians often may not recognize or know how to address the needs that these patients have in managing their own health.

Initiating palliative care consults for advanced dementia patients in the emergency department.

Background: Patients with dementia, an underrecognized terminal illness, frequently visit the emergency department (ED). These patients may benefit from ED-initiated palliative care (PC) consultation.

Objective: The study's objective was to track the rate of ED-initiated PC consultation for patients with advanced dementia (AD) after an educational intervention, and to categorize decision making for physicians who chose not to initiate consultation.

Treating persistent pain in the elderly: how do we proceed?

Objective: To describe a performance improvement initiative conducted in accordance with the American Geriatrics Society (AGS) guideline regarding pharmacological management of persistent pain in older adults.

Settings: Medical units of a tertiary care teaching hospital.

Practice Description: Elderly patients were included if treated for conditions associated with persistent pain.

Ethnicity, race, and advance directives in an inpatient palliative care consultation service.

Objective: Although race and ethnic background are known to be important factors in the completion of advance directives, there is a dearth of literature specifically investigating the effect of race and ethnicity on advance directive completion rate after palliative care consultation (PCC).

Method: A chart review of all patients seen by the PCC service in an academic hospital over a 9-month period was performed. Data were compiled using gender, race, ethnicity, religion, and primary diagnosis.

Transforming the mortality review conference to assess palliative care in the acute care setting: a feasibility study.

Objective: This project sought to evaluate the impact of a hospital-based Palliative Care Consultation (PCC) service utilizing a common practice: the resident mortality review conference.

Method: Internal Medicine residents used a revised chart audit tool during the mortality review conference, which included domains described in the Clinical Practice Guidelines for Quality Palliative Care (2004). This study attempted to transform the common practice into a methodology for collecting data that could be used as a platform to assess the quality of hospital care near the end of life.