Characterizing the Use of Emergency Department Resources and Dispositions of Hospice Patients in an Appalachian Region of the United States

Abstract

Objective

Appropriately using resources is challenging for emergency providers managing hospice patients who desire palliative, rather than curative, care. In the Emergency Department (ED), the goals of such visits may be unclear. Our study examined the chief complaints of hospice patients presenting to the ED and associations with ambulance use, advanced imaging, and hospital admission.

Methods

A retrospective review was conducted of 2678 visits by 1281 hospice patients from 2017-2022 in a rural health system in Appalachia. Data collection included demographics, chief complaint, mode of arrival, disposition, and use of advanced imaging. Statistical analyses for associations were conducted using the Chi-Square test and post-hoc analysis with Bonferroni correction.

Results

Respiratory, abdominal, neurologic, and trauma complaints were most common. Ambulance was the mode of arrival for 65.8% and was associated with neurologic concerns and trauma (P < 0.001). Advanced imaging was used in 55.0% of visits and was associated with abdominal concerns, neurologic issues, and trauma (P < 0.001). Admission occurred in 64.4% and was significantly associated (P < 0.001) with neurologic, respiratory, and weakness complaints.

Conclusion

The most frequent reasons for ED visits by hospice patients in this study included respiratory, abdominal, neurologic, and trauma complaints. Most ED hospice patients used ambulance services and advanced imaging resources and were admitted. When the goals of the visit are unclear, the ED provider may default to ordering evaluations. Further studies are needed to determine how to best provide goal-concordant support for hospice patients with emergent medical needs.