PRIM-ER Trial Finds Palliative Care Training in Emergency Departments Does Not Reduce Hospital Admissions

PRIM-ER Trial Outcomes on Palliative Care Training

An extensive study known as the PRIM-ER trial has revealed that a specialized training program aimed at enhancing palliative care communication skills among emergency department staff did not result in reduced hospital admissions for seriously ill older adults. The findings, published ahead of print in JAMA, highlight the challenges in integrating palliative care into emergency medicine practices.

Study Design and Implementation

The PRIM-ER trial, supported by the NIH Pragmatic Trials Collaboratory with a grant from the National Institute on Aging, was conducted across 29 emergency departments in the United States. The program included palliative care training, simulation-based communication workshops, clinical decision support tools, and audit and feedback mechanisms. The study evaluated the initial emergency department visits of nearly 99,000 older adults with serious, life-limiting illnesses, comparing outcomes before and after the training intervention.

Key Findings

• Primary Outcome: No significant difference in hospital admission rates was observed following the palliative care training intervention.
• Secondary Outcomes: The intervention also did not affect subsequent healthcare use or short-term mortality rates among the study population.

Expert Commentary

Dr. Corita Grudzen, an emergency medicine physician and palliative care specialist at Memorial Sloan Kettering Cancer Center, who led the study, commented on the outcomes. "Our complex, multicomponent intervention designed to embed palliative care skills in emergency medicine practice for patients with serious, life-limiting illness did not show an effect on hospital admission, subsequent health care use, or short-term mortality," Grudzen stated. She emphasized the ongoing need for primary palliative care interventions, citing workforce shortages in hospice and palliative medicine.

Impact of COVID-19

The trial's execution between 2018 and 2022 coincided with the COVID-19 pandemic, which introduced unforeseen challenges. The strain on the healthcare system limited the capacity of home care and hospice agencies to accept patients, potentially influencing the trial's results by narrowing referral options for emergency department clinicians.

Conclusion

Despite the trial's outcomes, the PRIM-ER study contributes valuable insights into the complexities of integrating palliative care into emergency medicine. It underscores the necessity for continued research and development of effective interventions to address the needs of seriously ill older adults, especially in the context of current workforce challenges.