Date of Completion
Summer 2026
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Jill Schramm, DNP, FNP-C, BCADM, CDCES
Second Advisor
Lydia Forsythe, PhD, MA, MSN, RN, CNOR
Third Advisor
Melanie Brewer, DNSc, RN, FNP-BC, NEA-BC, FAANP
Abstract
This quality improvement project evaluated the implementation of the Palliative Care and Rapid Emergency Screening (P‑CaRES) tool to improve early identification of unmet palliative care (PC) needs among adults with advanced, life‑limiting illnesses presenting to a community emergency department (ED). The problem addressed was the absence of a standardized PC screening process, resulting in delayed recognition, missed referral opportunities, fragmented care, and repeated ED utilization. Guided by Plan‑Do‑Study‑Act cycles and the OhioHealth Change Management Model, the project integrated P‑CaRES into ED workflows, provided staff education, and established structured referral pathways. Over 12 weeks, clinicians completed 65 screenings; 57 patients met eligibility criteria, and 47 received PC referrals. Referral rates improved from 76.2% in January to 91.0% in March, yielding an overall referral rate of 82.5%. Screening identified clinically relevant populations, primarily those with congestive heart failure, chronic obstructive pulmonary disease, and end‑stage renal disease. Balancing measures indicated no substantive workflow disruption, and preliminary financial modeling suggested potential organizational value through reduced avoidable acute care utilization. Findings demonstrated that standardized screening strengthened systematic identification of PC needs, improved referral follow‑through, and supported patient‑centered, goal‑concordant care. The project confirmed that ED‑based PC screening is feasible, operationally sustainable, and aligned with national priorities emphasizing early PC integration. Future cycles should incorporate automated electronic health record prompts, expanded measurement of symptom outcomes, and validated return‑on‑investment analyses to further enhance sustainability and organizational impact.
Recommended Citation
Sullivan, James, "Identifying Palliative Care Needs in the Emergency Department" (2026). Doctor of Nursing Practice (DNP) Scholarly Project. 70.
https://fuse.franklin.edu/dnp-project/70
Rights
Copyright, all rights reserved
