Palliative Care Screening Without Consultation: An Implementation Gap in Geriatric Emergency Department Palliative Care Screening

Context: The Palliative Care and Rapid Emergency Screening (P-CaRES) tool identifies emergency department (ED) patients with unmet palliative care needs. Whether a documented positive screen changes consultation when no referral pathway is attached has not been reported. Objectives: To describe inpatient specialty palliative care consultation after P-CaRES screening in a geriatric ED where results generated no alert, order set, or referral. Methods: Retrospective cohort study of patients 65+ screened with P-CaRES from 2019 to 2024, comparing P-CaRES-positive and -negative patients; the primary outcome was inpatient specialty palliative care consultation. Results: Of 421 patients, 115 (27.3%) screened positive; they were older with longer hospitalizations. Consultation rates were nearly identical between positive and negative patients (13.9% vs. 13.7%, p = 1.00). Conclusion: P-CaRES identified older adults with serious illness but showed no meaningful difference in consultation (95% confidence interval [CI] excluded differences >8 points), indicating that a passively documented positive screen was not associated with specialty consultation.