October Note From the President and CEO

Helping is not enough; we must transform healthcare in America.

by Kim Callinan
Oct 30, 2023 Kim Callinan author newsletter October 2023 newsletter

My grandmother died before I was an “in-the-know” end-of-life care advocate. 

She had completed her advance directive that included a do not resuscitate order. She communicated her preferences to her doctor and my parents. However, when a crisis landed her in the hospital, the emergency room team ignored her advance directive and resuscitated her back to “life.” She was outraged and protested by trying to rip her tubes out. My grandmother died exactly the way she expressly said she did not want to. And she left behind a family who carries the guilt of feeling we let her down in her final moments. 

Since joining Compassion & Choices, I have come to hear similarly tragic stories from people across the country. When I stop and think about it, it makes sense: Our emergency departments doing exactly what they are designed to do — save lives, resuscitate and stabilize. And people are doing exactly what they are instructed to do when an urgent medical situation arrives — call 9-1-1 or go to the emergency department. 

Emergency department care saves people, without question. And for much of our lives we are blessed to have access to such incredible care. 

Yet most terminally ill or frail patients are like my grandmother. They do not want aggressive treatment that artificially extends their life, especially painful interventions that prolong suffering.  

However, our emergency department clinicians are doing what they have been trained to do. So unless we implement a different model of care, we will never create a different end-of-life experience. 

Furthermore, emergency departments are the primary path into hospitals for patients near life’s end. In fact, 50% of older adults visit the emergency department in their last month of life.

Fortunately, pioneers in palliative care and emergency medicine have come together and developed an innovative program to help ensure that when a person enters the emergency department they get appropriate care and treatment that matches their values and priorities. 

The solution is integrating palliative care into emergency departments. One way this is done is by training emergency physicians to ask themselves a “surprise question”: Would I be surprised if this patient died within a year? If the answer is no, it triggers a palliative care consultation, which leads to end-of-life conversations and collaboration with an interdisciplinary team of doctors, APRNs, nurses, social workers and chaplains. 

Data demonstrates that when palliative care is integrated into the emergency department we improve a patient’s quality of life, health outcomes and satisfaction all while reducing costs! 

However, this model of care is currently being implemented only in a handful of emergency rooms across the country. That’s why emergency rooms are an essential new frontier in the work of Compassion & Choices and the reason we have launched our National Emergency and Palliative Medicine Initiative (NEPMI).

Through NEPMI we hope to help medical systems, especially small community hospitals that do not have palliative care teams, understand how to set up similar programs in their own facilities.   

Compassion & Choices is acting as a convener in this ambitious and far-reaching initiative. In the coming months, we will continue to align providers, health systems, payers and relevant medical associations to develop and share best practices. Our network of medical professionals will then offer guidance to help more hospital administrators integrate palliative care into their emergency departments. 

And in time, this systemic change work has the potential to transform the way end-of-life care is delivered. We can ultimately create a more balanced healthcare industry that both saves lives and supports people in death.