The Miriam Hospital is piloting a new approach to its care for emergency department (ED) patients that provides more compassionate care to those with chronic and life-threatening illnesses in a more efficient manner. With the addition of Leah McDonald, MD, a palliative care physician, to its ED team, The Miriam becomes the only hospital in Rhode Island to provide palliative care in the emergency department.
This approach to critical care translates into fewer extended hospital stays for patients, greater personalized patient care, and better quality of life for patients – of all ages – with grave conditions such as heart disease and cancer, and life-limiting and vulnerable conditions such as dementia, Parkinson’s Disease, and more.
An emergency department visit can be the most vulnerable time of a person’s life. Leah McDonald, MD, alleviates the stress at The Miriam, the only hospital in Rhode Island to provide palliative care to emergency department patients.
Palliative care is specialized medical care that focuses on providing patients supportive care and relief from pain and other symptoms of a serious illness, no matter the diagnosis or stage of disease. Palliative care teams work to improve the quality of life for both patients and their families. This form of care is offered alongside curative or other treatments the patient may be receiving.
“With the support of Dr. McDonald and her team, we are able to intervene sooner to bring palliative care to patients who need it,” said Mark Deitch, MD, senior vice president of medical affairs and chief medical officer, The Miriam. “By assessing the patient’s potential for palliative care at the time of their emergency visit, we can get patients the relief they need, avoid any unnecessary treatments, and reduce the time the patient and their family spends in the emergency room.”
It was during her residency in emergency medicine, while working with highly trained emergency department teams, that Dr. McDonald diagnosed a void in patient care. “I realized that there was little to no discussion with the patient about what it means to have a critical or life-limiting illness,” she said. “That led me to palliative care and being able to better communicate with patients.”
A visit to an emergency department can be one of the most vulnerable times of a person’s life.
In addition to her specialized role in The Miriam’s ED, Dr. McDonald is one of a large team of hospice and palliative physicians and nurse practitioners with HopeHealth, the major teaching affiliate for palliative care at The Warren Alpert Medical School of Brown University and Brown University Health's exclusive partner for inpatient hospice and palliative care.
Dr. McDonald describes the type of care she provides in the ED. “I am an emergency medicine physician who specializes in palliative care,” she said. “I talk with patients about the goals of their care and symptom management. I try to figure out why they have come to the ED and how it fits into their illness. Are they hoping to return home? Or do they want to be admitted? It’s a pivotal point where we can save people from being admitted.”
“A visit to an emergency department can be one of the most vulnerable times of a person’s life,” David Curley, MD, medical director, The Miriam Hospital Emergency Department said. The HopeHealth palliative care team at The Miriam conducts consultations monthly throughout the hospital. This pilot program brings those consultations directly to those patients being evaluated in the ED. For some, this intervention amidst the busy activity of the emergency department can eliminate an unnecessary stay in the hospital or additional invasive and costly testing. Patients with conditions that are manageable can return to the comfort and privacy of their own home where they will have the support of a palliative care or hospice team. Others are admitted for inpatient care that has been deemed necessary.
Overall, palliative care improves patient outcomes without reducing their prognosis or survival rate. A study in the Journal of Palliative Medicine (Journal of Palliative Medicine, 2013 16:11, 1362-1367) revealed that discussions about palliative care with patients that occur early during their ED visit were associated with a significantly shorter length of stay and lower cost of care for those patients admitted to the hospital. In Dr. McDonald’s experience, she has seen the impact of her conversations with patients. “They feel they’ve been communicated with,” she reflected. “We’ve listened to their wishes and needs.”
A palliative care program has been at Rhode Island and its Hasbro Children's hospitals, The Miriam Hospital, and Newport Hospital, as well as at the outpatient Brown University Health Cancer Institute, including locations in Bristol and East Greenwich. As the pilot ED palliative care program rolls out, consideration is underway to offer it at other Brown University Health affiliate hospitals.
