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Diana Franchitto[/caption]
When the television show “ER” debuted in 1994, it defined how millions of Americans came to understand emergency medicine. We saw fast-paced scenes, young doctors racing down hallways, and countless traumas resolved – more or less – within an hour.
Fast forward 22 years and the hit HBO medical drama “The Pitt” has taken a more realistic lens to the inner workings of the emergency department. Viewers not only see the heroics and trauma of emergency medicine but also the thoughtfulness, care and emotional complexity that goes into treating every patient.
The shift in care depicted in the show accurately reflects how patients and families are cared for more holistically in the emergency department. Critically, “The Pitt” reveals the psychosocial perspective of social workers and how they help to defuse emotionally charged situations in a measured way.
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Leah McDonald[/caption]
But there is one specialization that also receives attention on “The Pitt.”
Emergency departments are a common point of entry for individuals living with serious illnesses. It is understandable for patients to seek rapid intervention in the emergency department when pain becomes severe or other symptoms cannot be managed at home. However, invasive or curative treatments alone are not always the best path for a patient nearing the end of life.
In the first season, we watch a family struggling to accept their beloved father’s decline. In the fifth episode of the second season, viewers meet Roxie, a woman with end-stage cancer who needs treatment for a leg injury that has resulted from her weakened state. The Pitt staff compassionately treats the leg injury and also Roxie’s emotional and pain management needs.
Palliative care focuses on the comfort and quality of life of the patient by managing symptoms alongside any other care they may be receiving. A common misperception is that traditional medical treatments are not available once a patient enters palliative care. The goal, instead, is to help patients and families better understand their next steps when treatments are no longer delivering the same or desired benefit. In the emergency department, palliative care helps address a patient’s immediate symptoms while supporting them as they consider their next steps.
Patients who receive early palliative care in the emergency department spend three fewer days in the hospital, on average, than similar patients who are admitted without it. Three days matter for emergency departments managing crowding and boarding while patients wait for the next level of care in an inpatient unit. Shorter lengths of stay free much-needed beds in hospitals, while greatly improving the experience of patients who are often much more comfortable at home in their own beds.
For the patient, earlier palliative care brings important symptom management, psychosocial support and spiritual support in an overwhelming environment. Patients are also less likely to return to the emergency department, benefiting the patient and the hospital, and lowering health care costs.
Actor Noah Wyle is certainly more seasoned in his return to the emergency department in “The Pitt,” but so too is the field of emergency medicine, which has matured greatly. Palliative care is earning its place in this progression so that individuals can live life with clarity, comfort and dignity.
Diana Franchitto is CEO and president of HopeHealth, a nonprofit hospice and palliative care organization based in Providence. Dr. Leah McDonald is a physician leader at HopeHealth and double board-certified in emergency medicine and hospice and palliative care.
