Development and Evaluation of an Emergency Department-Embedded Palliative Care Model Using a Logic Model Framework

Emergency departments (ED) are frequent points of care for patients experiencing serious illness. Despite the recommendation for early palliative care (PC), it is often initiated late in the hospital course leaving many patients with unmet PC needs. These gaps contribute to unmanaged symptoms, delayed goals-of-care discussions, admissions that may not align with patient values, and higher rates of in-hospital mortality. While ED-embedded PC may help address these challenges, data around implementation is limited.

We applied a logic model framework to guide implementation and evaluation of a multidisciplinary ED-embedded PC consult services at an academic institution. Inputs included a multidisciplinary team consisting of a Registered Nurse (RN) Navigator, PC clinician, social worker, and case manager. Core activities include systematic screening of ED patients for unmet PC needs and interventions including serious illness conversations, prognostic disclosure, acute symptom management, and terminal care planning. Disposition pathways include direct discharge to hospice, home-based PC, or admission to a palliative care unit (Supportive Care Unit) for acute symptom control and/or goals-of-care support. Outputs include total consult volume and patient characteristics. Outcomes focused on goal-concordant disposition (e.g., discharge directly to hospice), 30-day ED readmission rates, and total hospital days saved. Prospective data was collected from July 2023 through September 2024.

Over the 14-month study period, RN Navigators screened approximately 7,800 patients, resulting in 3,063 encounters with 2,452 unique patients. The service facilitated alternative dispositions for 7% (n=173) of patients; of these, 25% were discharged directly to hospice and 30% to home-based PC. The 30-day ED readmission rate for the cohort was 12%, significantly lower than national trends of 20–25% for similar populations. Program data estimated a 44% reduction in total hospital days post-intervention, representing over 6,500 inpatient days saved.

Use of a logic model framework supported the successful implementation and evaluation of a multidisciplinary, ED-embedded PC model. The approach was feasible and associated with improved goal-concordant care and reduced hospital utilization. This model may offer a scalable strategy to address unmet PC needs in the ED.