Benefits of Emergency Department-Initiated Goals of Care Conversations and Palliative Care Consultations Among Older Adults with Chronic or Serious Life-Limiting Illnesses.

For older adults with serious illnesses, delaying goals of care (GOC) discussions until admission may worsen unmet palliative needs and increase costly interventions. We compared emergency department (ED) versus inpatient GOC conversations and palliative consultations and their impact on outcomes and cost savings. We analyzed records (July 2021-June 2023) of patients ≥65 years old admitted from our suburban level 1 trauma and quaternary care hospital. Included patients received a GOC conversation or palliative consultation in the ED or inpatient settings. We excluded patients discharged from the ED, directly admitted, or expired in the ED. Primary outcome: total length of stay (LOS). Secondary outcomes: intensive care unit (ICU) days, excess days in acute care (EDAC), contribution margin, and hospice discharge odds. Multivariable regression models assessed differences in outcomes in ED versus inpatient conversations and palliative consultations. A total of 7326 patients received a GOC conversation (18.1% ED). A total of 2976 received a palliative consultation (8.1% ED). Adjusting for age, race, ethnicity, case mix index, and admission source, ED-initiated GOC conversations were associated with reduced total LOS (β = -2.82 days, 95% CI: -3.50, -2.15), fewer EDAC (β = -2.72 days, 95% CI: -3.40, -2.03), and increased contribution margin (β = $2689, 95% CI: $1214, $4165). ED-initiated palliative consultations were associated with reduced total LOS (β = -6.73 days, 95% CI: -8.66, -4.81), fewer EDAC (β = -6.05 days, 95% CI: -7.99, -4.10), fewer ICU days (β = -0.98 days, 95% CI: -1.68, -0.27), and increased hospice discharge odds (odds ratio: 1.59, 95% CI: 1.14, 2.22). ED-initiated GOC conversations and palliative consultations among older adults are associated with improved outcomes and increased cost savings.