Prevalence of patients with unmet palliative care needs in a University Emergency Department in Germany - a cross-sectional screening study.

BACKGROUND: People with life-limiting diseases can benefit from early integration of palliative care, yet early identification of these patients is challenging. Emergency Departments (ED) often serve as the initial contact point for hospital admissions due to acute medical problems, providing an opportunity to recognize palliative care needs. This study aims to determine the prevalence of unmet palliative care needs among patients presenting to the ED of a German university hospital and to assess the proportion of these patients already receiving outpatient palliative care services. METHODS: We conducted a cross-sectional study at the ED of Hannover Medical School over a 30-day period in April and May 2022. All patients aged 18 years or older who were seen by a specialist in either internal medicine or general medicine in the ED were eligible to participate and screened using the Palliative Care and Rapid Emergency Screening Tool (P-CaRES) to identify those with unmet palliative care needs. Data were collected by on-duty physicians. For analysis, we used standard descriptive statistics. RESULTS: During the study period, 1,122 patients presented to the ED and were seen by a specialist in either internal medicine or general medicine. 1,090 could be included in the study (inclusion rate: 97.1%). At least one life-limiting disease was identified in 280 of the 1,090 patients (25.7%). Of these, 173 patients had two or more potentially unmet palliative care needs, as determined by the P-CaRES screening tool. At the time of assessment, 11.6% of these patients were already receiving outpatient palliative care. CONCLUSION: A significant proportion of patients presenting to the ED of a university hospital appear to have unmet palliative care needs according to P-CaRES. However, only a small fraction of these patients were known to have pre-existing outpatient palliative care support which could indicate a considerable gap in palliative care provision. Promoting the integrating of palliative care into emergency medicine could substantially enhance patient care by promoting holistic, patient-centred approaches that extend beyond acute medical treatment and facilitate the early implementation of outpatient palliative care services.