One-third of Americans will visit an emergency department, or ED, within a month of their death. While EDs are primarily purposed to provide emergent care, they’re increasingly becoming an initial touchpoint for hospice and palliative care, or HPC, referrals and consultations, according to a new study from several researchers at Henry Ford Health + Michigan State University Health Sciences.
The article, which will appear in the November 2025 issue of the American Journal of Emergency Medicine, shares findings from the largest study to date that evaluates hospice and palliative care consultations initiated in the ED. While both services focus on providing care to those facing serious illness, palliative care serves individuals regardless of their medical prognosis and hospice is reserved for individuals nearing the end of their lives due to terminal illness. This study evaluated 8,055 ED-initiated HPC consults at five Henry Ford Health EDs in the metro Detroit area from 2016 to 2023. Researchers evaluated and reported trends in HPC consultations initiated in the ED.
Among the findings:
Palliative care accounted for 58% of all HPC consultations, highlighting a culture shift across a health system and emergency medicine whereby palliative care patients are more likely to receive proactive clinical assessment and management initiated from the ED. Historically, HPC needs were not addressed until patients were admitted to the hospital or discharged to community-based services.
During the study’s timeframe, hospice referrals decreased from 48.2% to 21.9%, whereas palliative care referrals increased from 27.4% to 53.6%.
In the five years since the COVID-19 pandemic, HPC consultations in EDs have increased 173.6%, suggesting the pandemic highlighted the importance of HPC in the ED.
“The increase in consults following the pandemic underscores a heightened awareness of palliative care’s crucial role, particularly as COVID-19 intensified the demand for end-of-life care,” said Fabrice Mowbray, the study’s supervising author and lead methodologist. Mowbray also serves as director of the Data Center at the Michigan State University College of Nursing.
The study also noted prior research showing palliative care teams in U.S. hospitals increasing from 20% in 2000 to 84% in 2022 (for sites with at least 50 beds), demonstrating a cultural shift above and beyond what was noted at HFH.
“A growing body of literature supports these recommendations with evidence that increasing access to hospice and palliative care consults in both the ED and inpatient settings can improve goal-focused care, enhance patient and family satisfaction and improve quality of life during the end stage of a patient’s life,” Mowbray said.
He added that as the demand for palliative care in the ED continues to rise, health care providers must continue to provide policy, education and research to enhance care for those with life-limiting illnesses.
“Palliative care, as a specialty, is relatively new in the United States, having only received formal board certification in 2006,” said Satheesh Gunaga, the paper’s lead author and an emergency care physician at Henry Ford Health. “That is why research like this is so important, so that we can work together to improve the lives of some of our most vulnerable patients.”
Additional researchers on the study include Abe Al-Hage, MSU College of Osteopathic Medicine and Henry Ford Health; Alyssa Buchheister, MSU College of Osteopathic Medicine and Henry Ford Health; Harish Neelam, MSU College of Human Medicine; Jessica Corcoran, MSU College of Osteopathic Medicine and Henry Ford Health; Michael Welchans, Henry Ford Health; Kirby Swan, MSU College of Osteopathic Medicine and Henry Ford Health; Mahmoud Awada, MSU College of Human Medicine; and Joseph Miller, MSU College of Human Medicine and Henry Ford Health.
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