Life In The Slower Lane

Here is the standardised PICO analysis for the thirty-sixth uploaded article:

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Full Title

Does an Integrated Palliative Care Program Reduce Emergency Department Transfers for Nursing Home Palliative Residents?

Authors: Peiyan Ho, Yujun Lim, Laurence Lean Chin Tan, et al.

Journal: Journal of Palliative Medicine, 2022; 25(3):361–367

DOI: 10.1089/jpm.2021.0241

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Type of Study

Retrospective cohort study

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PICO Summary

Population (P)

• Nursing home residents with palliative care needs in 5 facilities in Singapore
• Inclusion criteria:
  • Life-limiting illness with prognosis <1 year
  • Symptomatic on ESAS-R (Edmonton Symptom Assessment Scale – Revised)
  • ≥2 hospital admissions in the prior year
• Total: 187 unique residents, 217 telemedicine consults over 27 months

Intervention (I)

GeriCare Palliative Care Program – a multipronged, integrated model including:

1. Telemedicine consultations (scheduled and urgent)
2. On-site clinical preceptorship by hospital palliative nurses
3. Advance Care Planning (ACP) advocacy
4. Competency-based staff education (41 hours of training with OSCE assessment)

Comparison (C)

• No explicit control group, but compared rates of emergency department (ED) transfers among those with and without ACP documentation and different care goals

Outcomes (O)

Primary outcome:

• Reduction in ED transfers
  • 82% of urgent telemedicine consults successfully averted ED transfers

Secondary outcomes:

• Gender and ACP completion were statistically associated with ED transfers
  • 59% of ED-transferred residents had ACP vs 75% of non-transferred (p = 0.041)
  • ED transfer group was more likely to have “limited intervention” as care goal, while non-ED group more often chose “comfort care” (p < 0.001)

Qualitative/system-level outcomes:

• Program enabled residents to age-in-place and reduced burdensome hospitalisation
• On-site mentoring improved nurse confidence, ACP discussions, and symptom control
• Telemedicine remained effective during COVID-19 disruptions by shifting ACP and training online 

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Findings Summary

This integrated palliative care program demonstrated substantial impact in reducing ED transfers from nursing homes by:

• Empowering NH nurses through telehealth, mentoring, and ACP training
• Enabling timely decision-making consistent with residents’ goals of care
• Providing continuity and quality of care during acute events and EOL phases

The program’s strength lies in its synergistic approach, combining clinical, educational, and advance care planning components into a single model. The findings suggest that such integration can preserve dignity, reduce health system burden, and offer a replicable framework for high-quality nursing home palliative care.

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