• Myra Glajchen, Robin Lawson, Peter Homel, Paul Desandre, and Knox H Todd.
• Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York 10003, USA. mglajchen@chpnet.org
• J Pain Symptom Manage. 2011 Nov 1;42(5):657-62.

BackgroundA rapid two-stage screening protocol was developed to improve referral for palliative care needs among frail elderly in the emergency department (ED).MeasuresA new triage tool was administered, with assessment tools for activities of daily living, performance, functional staging, symptom burden, and caregiver distress.InterventionStage One identified elderly patients meeting criteria for life-limiting conditions. Stage Two referred patients with crescendo losses in activities of daily living, high symptom burden, and caregiver distress to palliative care or hospice.OutcomesOver eight months, 1587 patients were screened, representing 22% of ED visits made by patients older than 65 years during this time period. Of these, 140 met functional decline criteria, and 51 of these needed palliative care consultation. Five patients were referred to hospice, 20 received palliative care, and 26 received no further service.Conclusions/Lessons LearnedThe project shows unmet needs among elderly ED patients, and the feasibility of rapid screening and referral using a quality improvement approach. At its peak, the project accounted for half the referrals to the palliative care consultation service.Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

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