Palliative Social Work in the Emergency Department

Abstract

Abstract Patients with serious illness and their families go to the emergency department (ED) for acute crises with symptom management, caregiver distress, or for management of end-of-life issues. Unmet palliative care needs in the ED include clarification of advance directives, goals-of-care discussions, symptom management, and engaging with families and patients who may die in the ED. Many factors in the emergency department can influence the occurrence and success of these conversations, including provider comfort in having these conversations, availability of social work and palliative care resources, as well as the physical environment of the ED. Social workers within the context of the emergency department are uniquely positioned to build rapport and have advance care planning discussions with seriously ill patients who may also experience mental illness, substance abuse, and homelessness, and may be unlikely to access care in outpatient settings. For our most vulnerable patients, the ability of a social worker to build rapport across multiple ED visits and to outreach community partners, can improve patient autonomy and inform future treatment decisions. Both ED and palliative social workers can improve the care that seriously ill patients receive in the ED by identifying unmet palliative care needs and providing primary and specialist palliative care interventions.