Palliative Care Screening and Consults in the Emergency Department

Background: As the demand for palliative care (PC) increases, emergency departments (EDs) are important in initiating early PC screening and consults. While a Palliative Care and Rapid Emergency Screening (P-CaRES) tool exists, PC consults remain infrequent in EDs. We aimed to determine the current PC needs in a Saskatoon ED by identifying patients meeting eligibility requirements for PC consults and comparing them with current consult rates.

Methods: A retrospective chart review of patients with life-limiting illnesses presenting to St. Paul’s ED in October and December 2024. Patients were screened using P-CaRES criteria to determine PC consult eligibility. Analysis included descriptive statistics and comparisons using Chi-square and Fisher’s exact tests.

Results: 189 charts were included in the PCaRES screening; 68.8% met criteria for a PC consult, and 3.7% received one (p<0.0001). Advanced cancer patients represented 9.02% of those eligible for consult but accounted for 86% of the consults (p<0.0001). Consulted patients had higher in-hospital mortality (57.1%) than those eligible but not consulted (9.8%) (p=0.0002).

Discussion: PC consults are frequently missed in the ED, especially for non-malignant conditions, and are often initiated later in a patient’s illness course. These findings highlight an opportunity to improve patient care through earlier screening and timely referrals to PC services.