Choosing Wisely:

Don’t delay engaging available palliative and hospice care services in the emergency department for patients likely to benefit.

Rationale and Comments: Palliative care is medical care that provides comfort and relief of symptoms for patients who have chronic and/or incurable diseases. Hospice care is palliative care for those patients in the final few months of life. Emergency physicians should engage patients who present to the emergency department with chronic or terminal illnesses, and their families, in conversations about palliative care and hospice services. Early referral from the emergency department to hospice and palliative care services can benefit select patients resulting in both improved quality and quantity of life.
Sponsoring Organizations:
  • American College of Emergency Physicians
  • Sources:
  • Expert consensus
  • Disciplines:
  • Emergency medicine
  • References: • DeVader TE, DeVader SR, Jeanmonod R. Reducing cost at the end of life by initiating transfer to inpatient hospice in the emergency department. Ann Emerg Med. 2012;60(4s):S73.
    • Kenen J. We can’t save you: how to tell emergency room patients that they’re dying. Slate [Internet]. 2010 Aug 4 [cited 2013 Sep 4]. http://www.slate.com/id/2262769/.
    • Quest TE, Marco CA, Derse AR. Hospice and palliative medicine: new subspecialty, new opportunities. Ann Emerg Med. 2009;54:94-102.
    • Smith AK, McCarthy E, Weber E, Cenzer IS, Boscardin J, Fisher J, Covinsky K. Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff. 2012 Jun 31:1277-85.

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