Trends in hospice and palliative care consults initiated in the emergency department: An eight-year utilization analysis.

Abstract

Background: Emergency departments (EDs) play a central role in end-of-life care, yet the early integration of hospice and palliative care (HPC) is often underutilized. Early access to HPC improves outcomes, aligns care with patient goals, and reduces costs. However, incorporating primary and specialized palliative care resources in the ED remains inconsistent, and utilization trends are not well understood. Our study evaluates the incidence and trends of ED-initiated HPC consults over 8 years within a large metropolitan health system.

Methods: We conducted a retrospective cohort study of electronic health records from 5 EDs between 2016 and 2023. Our cohort included all ED visits where HPC consults were ordered. We examined the annual number of HPC consults, patient demographics, and health outcomes. A subgroup analysis evaluated HPC consults per 1000 ED patients aged 60 or older admitted for inpatient care.

Results: A total of 8055 HPC consults were ordered for 6370 unique patients. The average age was 78.1 years, with 56.4 % female and 75.0 % White. Of the cohort, 91.7 % were admitted, 5.3 % discharged home, and 53.2 % died in-hospital. HPC consults increased from 369 in 2016 to 1355 in 2023 (367 % increase, p < 0.001). The ratio of hospice to palliative care consults reversed from 1.5:1 in 2016 to 1:1.9 in 2023. Post-COVID-19, daily HPC consults rose by 173.6 % compared to pre-pandemic levels.

Conclusions: ED-initiated HPC consults increased significantly over time, suggesting an evolving role for EDs in delivering primary palliative care. Further research is needed to determine national trends and identify barriers to broader implementation.