患者经常在临终前去急诊室 (ED)。他们的共同倾向是住院，这可能导致延迟过渡到临终关怀，并最终导致住院患者死亡，这可能与他们的护理目标不一致。快速识别并招募临近生命尽头的符合条件的患者。这项针对新颖的多方面护理过渡计划的事前质量改进研究涉及电子邮件警报、临床医生培训、临终关怀供应商扩展、指标创建和数据的正式途径跟踪是在附属于综合癌症中心的大型城市三级护理学术医疗中心对在生命即将结束时到急诊科就诊的成年患者进行的。项目启动前的对照期为2018年9月1日至2020年1月31日，项目启动后的干预期为2021年8月1日至2022年12月31日。主要结局为无需住院即可过渡到临终关怀中心和/或在急诊室就诊后 96 小时内入院临终关怀中心。次要结局包括住院时间和院内死亡率。这项研究纳入了对照组的 270 名患者（中位年龄 74.0 岁 [IQR，62.0-85.0 岁]；270 名女性中有 133 名女性 [49.3%]），以及 388 名患者（中位年龄 74.0 岁 [IQR，62.0-85.0 岁]）。干预期间的中位年龄为 73.0 岁 [IQR，60.0-84.0 岁]；388 名女性中的 208 名[53.6%]）在急诊室到达后 96 小时内被确定为有资格接受临终关怀过渡。在对照期，61 名患者 (22.6%) 达到主要结局，而干预期有 210 名患者 (54.1%) 达到主要结局 (P < .001)。调整年龄、种族和民族、主要付款人、查尔森合并症指数以及生命维持治疗医嘱 (MOLST) 后，干预措施与主要结局相关（调整后的比值比，5.02；95% CI，3.17） -7.94）。此外，MOLST 的存在与所有组的临终关怀过渡独立相关（调整后的比值比，1.88；95% CI，1.18-2.99）。对照组和干预期的住院时间没有显着差异（中位数，2.0 天 [IQR，1.1-3.0 天] 与 1.9 天 [IQR，1.1-3.0 天]；P = .84），但干预期间的医院死亡率较低（48.5% [388 人中的 188 人] vs 64.4% [270 人中的 174 人]；P < .001）。在这项质量改进研究中，促进 ED 患者过渡的多学科计划与临终关怀服务的使用相关。需要进一步调查以检验该计划的普遍性和可持续性。

Patients often visit the emergency department (ED) near the end of life. Their common disposition is inpatient hospital admission, which can result in a delayed transition to hospice care and, ultimately, an inpatient hospital death that may be misaligned with their goals of care.To assess the association of hospice use with a novel multidisciplinary hospice program to rapidly identify and enroll eligible patients presenting to the ED near end of life.This pre-post quality improvement study of a novel, multifaceted care transitions program involving a formalized pathway with email alerts, clinician training, hospice vendor expansion, metric creation, and data tracking was conducted at a large, urban tertiary care academic medical center affiliated with a comprehensive cancer center among adult patients presenting to the ED near the end of life. The control period before program launch was from September 1, 2018, to January 31, 2020, and the intervention period after program launch was from August 1, 2021, to December 31, 2022.The primary outcome was a transition to hospice without hospital admission and/or hospice admission within 96 hours of the ED visit. Secondary outcomes included length of stay and in-hospital mortality.This study included 270 patients (median age, 74.0 years [IQR, 62.0-85.0 years]; 133 of 270 women [49.3%]) in the control period, and 388 patients (median age, 73.0 years [IQR, 60.0-84.0 years]; 208 of 388 women [53.6%]) in the intervention period, identified as eligible for hospice transition within 96 hours of ED arrival. In the control period, 61 patients (22.6%) achieved the primary outcome compared with 210 patients (54.1%) in the intervention period (P < .001). The intervention was associated with the primary outcome after adjustment for age, race and ethnicity, primary payer, Charlson Comorbidity Index, and presence of a Medical Order for Life-Sustaining Treatment (MOLST) (adjusted odds ratio, 5.02; 95% CI, 3.17-7.94). In addition, the presence of a MOLST was independently associated with hospice transition across all groups (adjusted odds ratio, 1.88; 95% CI, 1.18-2.99). There was no significant difference between the control and intervention periods in inpatient length of stay (median, 2.0 days [IQR, 1.1-3.0 days] vs 1.9 days [IQR, 1.1-3.0 days]; P = .84), but in-hospital mortality was lower in the intervention period (48.5% [188 of 388] vs 64.4% [174 of 270]; P < .001).In this quality improvement study, a multidisciplinary program to facilitate ED patient transitions was associated with hospice use. Further investigation is needed to examine the generalizability and sustainability of the program.