Translating Palliative Care into the Emergency Setting

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No one wants to think about the end of life, but many patients with chronic or terminal illnesses such as cancer or organ failure face this reality every day. To better serve these patients, the St. Joseph's Regional Medical Center (SJRMC) Emergency Department (ED) has introduced Life-Sustaining Management and Alternative (LSMA) services, a unique program designed to provide comfort, control and choices for chronic and terminally ill patients and their loved ones when faced with difficult end-of-life decisions.

"At St. Joseph's, we are translating palliative care into the emergency setting," explains Dr. Mark Rosenberg, Chairman of Emergency Medicine at SJRMC. "Our goal is to help patients remain in control of their lives as much as possible, and help them understand their disease. We work with them to improve their quality of life through the relief of pain and non-pain symptoms while also providing emotional, social and spiritual support."


A recent study published in the New England Journal of Medicine proved that this approach to palliative care actually prolongs life and alleviates stress and physical pain. Those receiving palliative care from the start, the authors said, reported less depression and happier lives as measured on scales for pain, nausea, mobility, worry and other problems. Fewer of these patients opted for aggressive chemotherapy as their illnesses worsened and many more left orders that they not be resuscitated in a crisis. This group of patients typically lived almost three months longer than the group of patients getting standard care, who lived a median of nine months.


The LSMA team is available for consultations 24/7 through the SJRMC Emergency Department. The core team is comprised of a physician, nurse and social worker, with the addition of other specialists as needed. The initial evaluation reviews the patient and family's access to hospital and community resources such as medical specialties, pastoral care, home and respite care, and legal services that will help them live more comfortably and independently.


"Many patients are not aware of the trajectory of their disease and what to expect," adds Rosenberg. "This program gives Emergency Department physicians at St. Joseph's a course of action, a chance to not only relieve pain and suffering, but to communicate effectively and work with the patient and family to establish treatment goals that support and honor their wishes."


"St. Joseph's is the leading health resource in the community and for the community, and our mission is to provide a comprehensive spectrum of services designed to heal the minds, bodies, and spirits of those in need, including those patients facing the end of life. The Life- Sustaining Management and Alternative services program provided by the St. Joseph's Regional Medical Center Emergency Department team dovetails into St. Joseph's Healthcare System's comprehensive Palliative Care Program designed to provide highly specialized and compassionate care for patients facing progressive illness and their families," says Sr. Maryanne Campeotto, Vice President, Mission, at St. Joseph's Healthcare System.


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