Research Summary

Primary Palliative Care Training in the Emergency Department and Its Impact on Admissions

Miranda Manier, BA

Key Highlights:

  • A multicomponent primary palliative care intervention for emergency department (ED) clinicians did not reduce hospital admissions among older adults with serious illness.
  • The intervention included education, simulation workshops, decision support, and feedback for emergency staff across 29 EDs.
  • No significant changes were observed in ICU use, ED revisits, hospice or home health use, readmissions, or mortality.
  • Findings suggest that scalable, clinician-focused palliative care training may not be sufficient to alter care trajectories in this setting.

In a cluster randomized, stepped-wedge trial involving 98,922 emergency department (ED) visits, a multicomponent primary palliative care intervention for emergency clinicians did not reduce hospital admissions among older adults with serious, life-limiting illness. Admission rates were 64.4% before the intervention and 61.3% afterward (adjusted OR, 1.03; 95% CI, 0.93–1.14). Secondary outcomes—including intensive care unit (ICU) admission, ED revisits, hospice or home health use, hospital readmissions, and 6-month mortality—also showed no significant differences.

The PRIM-ER (Primary Palliative Care for Emergency Medicine) intervention was developed to address the limited integration of palliative care into ED practice, despite evidence that ED visits often precede the final stages of life. The trial aimed to determine whether training ED clinicians in primary palliative care could shift decision-making away from hospitalization and toward more goal-concordant care options, such as discharge to home or hospice.

The intervention targeted full-time emergency physicians, physician assistants, nurse practitioners, and nurses at 29 EDs across the United States. Participating clinicians completed a 1-hour online course on primary palliative care, a 4-hour simulation-based communication workshop focused on serious illness conversations, and received audit and feedback reports on palliative care referrals. Clinical decision support tools were also embedded in the electronic health record to prompt appropriate use of palliative, home health, and hospice services. The training was implemented over a 3-week period at each site between 2019 and 2022.

Despite widespread clinician participation and implementation fidelity, the intervention did not lead to a significant reduction in the primary outcome of hospital admission. ICU admissions (7.8% preintervention vs 6.7% postintervention), ED revisits (34.2% vs 32.2%), and mortality (28.1% vs 28.7%) also remained statistically unchanged after adjusting for time trends and the effects of the COVID-19 pandemic.

“This multicomponent intervention to initiate palliative care in the ED did not have an effect on hospital admission, subsequent health care use, or short-term mortality in older adults with serious, life-limiting illness,” the authors concluded.

Reference:
Grudzen CR, Siman N, Cuthel AM, et al. Palliative care initiated in the emergency department: a cluster randomized clinical trial. JAMA. 2025;333(7):599-608. doi:10.1001/jama.2024.23696.