Evaluation of an Emergency Department-based Palliative Care Extender Program on Hospital and Patient Outcomes.

BACKGROUND: Boston Medical Center (BMC), a safety-net hospital, treated a substantial portion of the Boston cohort that was sick with COVID-19. Unfortunately, these patients experienced high rates of morbidity and mortality given the significant health disparities that many of BMC's patients face. Boston Medical Center launched a palliative care extender program to help address the needs of critically ill ED patients under crisis conditions. In this program evaluation our goal was to assess outcomes between those who received palliative care in the emergency department (ED) vs those who received palliative care as an inpatient or were admitted to an intensive care unit (ICU). METHODS: We used a matched retrospective cohort study design to assess the difference in outcomes between the two groups. RESULTS: A total of 82 patients received palliative care services in the ED, and 317 patients received palliative care services as an inpatient. After controlling for demographics, patients who received palliative care services in the ED were less likely to have a change in level of care (P<0.001) or be admitted to an ICU (P<0.001). Cases had an average length of stay of 5.2 days compared to controls who stayed 9.9 days (P<0.001). CONCLUSION: Within a busy ED environment, initiating palliative care discussions by ED staff can be challenging. This study demonstrates that consulting palliative care specialists early in the course of the patient's ED stay can benefit patients and families and improve resource utilization.

Improving the Care of Diverse Patient Populations: Let's Advance the Dialogue for Strategies to Address and Navigate the Elephant in the Room (P05)

Outcomes 1. Understand the development of cultural humility by completing a real-time self-assessment of implicit biases 2. Demonstrate recognition of individual implicit biases and exercise cultural curiosity via use of 1 or 2 components of the 5 “R”s tool, which includes cultural humility, mindfulness and compassion 3. Recognize 1 or 2 strategies intended to improve understanding of the cultural values and preferences of those from other cultures Cultural beliefs shape perceptions of illness, prognosis, and suffering and inform preferences for palliative and end-of-life care. Cultural identification encompasses many things: age, gender identity, ethnicity, ability, language, sexual orientation, religion, nationality, and socioeconomic status. Cultural identification and beliefs of patients often differ from those of their clinicians. This range of beliefs, values, and preferences in the clinician-patient relationship creates potential for discord, mistrust, and diminished quality of care. Studies suggest that clinicians and patients and families find interactions where cultural discordance exists challenging. Cultural humility has been found to enhance trust, increase the likelihood of clinically competent care, and increase satisfaction. Increasing clinicians’ cultural humility has been suggested as a mechanism for reducing healthcare disparities. Profound disparities in care have been exposed and exacerbated by the COVID-19 pandemic, which may relate to differences in cultural beliefs and mistrust in the healthcare system. Intentionally recognizing, evaluating, and addressing implicit bias and cultural humility, as well as honoring cultural values and preferences, are strategies that promote access to equitable, high quality, patient-centered care. This session will provide practical strategies and tools for clinicians caring for culturally diverse patients and their families. It will include facilitator-guided experiential learning within small groups using videos, role play, and discussion. Participants will learn and practice strategies to explore cultural beliefs, values, and preferences of those with serious illness and the impact on care preferences;develop shared understanding and exercise respect for individuals regardless of potential cultural-discordant dynamics;and enhance clinician resilience by understanding one's own implicit biases and practicing cultural humility strategies. The session will challenge individual beliefs and assumptions to facilitate personal and professional growth and will increase awareness of implicit biases, enhance confidence, and improve comfort in communication while promoting respect for those from cultural communities discordant with our own.