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We Need Palliative Care Everywhere

SMACC DUB 2016 Ashley Shreves, MD

Dept of Emergency Medicine Ochsner Medical Center

New Orleans, LA

Case

• 2009

• EMS: 93 y/o f, resp distress

• HR 25, BP 90/50, O2 sat 90%, RR 35

What happened next...

Specific challenges• Identify dying trajectory

• Capacity assessment

• Advance directives

• Difficult communication

• Withholding/withdrawing LST

• EOL symptom management

• Spiritual competency

• Ethics

• Systems of care

Maybe it’s just me

Conversations bad, brief or nonexistant

Dying patients “neglected;” staff uncomfortable

Dying in hospital: less respect, quality of care worse

WE ALL SUCK AT THIS

Relevant to you?

Canada: 1/3 cancer patients visit ED last 2 wks of life

Australia: 65% patients w serious illness die in hospital/ED

WE ALL SEE THESE PATIENTS

WHAT SHOULD WE DO?

Consult Palliative Care?

• Sure, but…

• 67% US hospitals (50+ beds) have pal care

• Workforce shortage: have 3K, need 18K (just in hospital)

• There will never be enough

Lupe D et al. J Pain Symptom Manage 2010 Dumanovsky T et al. J Palliate Med 2016

Kamal AH et al. Ann Intern Med 2015

Solution?

Fellowship

Mid-career courses

Online resources

We need palliative care everywhere