RPD304 - TelePalliative Care Promotes Goal-Concordant Care for Critically Ill Patients in the Rural Emergency Department

Key Message : Emergency department providers have limited access to specialty palliative care which often makes it challenging to provide goal-concordant care and avoid unnecessary escalation of care. Implementing telepalliative care in rural emergency departments significantly enhances goal-concordant care and can result in de-escalation of code status and reduction in low-value interhospital transfers.

Abstract: Emergency department clinicians care for critically ill patients and have limited access to palliative care. Decisions about transfer to distant hospitals may not align with the patient’s true goals. This abstract updates a prior report on the TeleGOC Pilot, a novel specialty-level palliative care telehealth intervention, using data from a larger patient sample.
In 2020, an interdisciplinary workgroup initiated the TeleGOC Pilot in which critically ill emergency department patients identified for interfacility transfer were risk stratified by a validated clinical decision-making tool (SafeNET Score). For each patient who met criteria, a telephone discussion between emergency, palliative, and critical care physicians occurred and was followed by a virtual consultation by the palliative care physician (TeleGOC Pause). The primary outcome was goal-concordant care plans achieved. Secondary outcomes included code status conversation, transfer, and hospital length of stay. Patients who elected to transfer were compared to those who stayed locally.
50 patients were included in this study. All patients were FULL code prior to the TeleGOC Pause. After telepalliative consultations, 94% of TeleGOC patients received a goal-concordant treatment plan, while 37 (74%) deescalated their code status (p < 0.001) and only 19 (38%) elected to transfer (p < 0.001). There was no significant difference in ED length of stay (p=0.5) between groups, however those who were transferred had a longer hospital length of stay compared to those who stayed locally (p < 0.01). Of all patients who elected to transfer, 10 (52.6%) died prior to discharge from the receiving hospital.
Timely specialty-level palliative care in the emergency department promotes goal-concordant care plans. This novel intervention is associated with a de-escalation in code status and reduction in goal-discordant transfers which has the potential to positively affect post-transfer in-hospital mortality. Further study will include the effect of TeleGOC on surrogate satisfaction and cost savings for the health system and insurers.

References: Altieri Dunn SC et al. SafeNET: Initial development and validation of a real-time tool for predicting mortality risk at the time of hospital transfer to a higher level of care. PLOSONE 16(2): e0246669. https://doi.org/10.1371/journal.pone.0246669