Carter Neugarten

All Publications

• Emergency Palliative Care: Hospice Patients in the Emergency Department. Journal of palliative medicine Neugarten, C., Baldeo, R., Engel, K., Wang, D., Lamba, S. 2023

  Abstract

  In this segment of the emergency department (ED) palliative care (PC) case series, we discuss a patient on hospice who presented to the ED for the management of acute symptoms and potential procedural intervention. Hospice patients frequently visit the ED and can challenge typical ED paradigms of care that often include resuscitative efforts and broad workups. Our patient had a history of advanced liver cancer, and his ED presentation was prompted by worsening abdominal pain from ascites requiring serial paracentesis. PC consultation was requested to help address the patient's symptoms and create a plan of care. The PC clinician played an important role in supporting aggressive symptom management, re-evaluating goals of care, addressing concerns about hospice, and facilitating changes in code status requested for a procedure.

  View details for DOI 10.1089/jpm.2023.0280

  View details for PubMedID 38011634

• Emergency Palliative Care: Severe Acute Neurological Injury With Poor Prognosis. Journal of palliative medicine Gacioch, B., Neugarten, C., Searls, D. E., DeSandre, P. 2023

  Abstract

  In this segment of the emergency palliative care case series, we present a patient who arrives at a small community emergency department with acute intracranial hemorrhage, aspiration, and respiratory failure. Usual care includes aggressive airway management with intubation and mechanical ventilation, and a recommendation from stroke neurologists and neurosurgeons at the tertiary care center to transfer the patient. The patient's wife has some understanding that the prognosis is likely to be poor, and asks that the patient not be transferred if he is unlikely to return to independent function. A general neurologist is consulted to provide a prognostic opinion, and goals-of-care discussions are facilitated by a palliative care consultant. After expedited evaluation, the neurologist provides a prognostic assessment, while the palliative care clinician explores potential next steps with the patient's wife, based upon his known goals and values, ultimately leading to high-value goal-concordant end-of-life care for the patient and his family.

  View details for DOI 10.1089/jpm.2023.0191

  View details for PubMedID 37870757

• National Survey of Emergency Medicine Physicians: Access, Barriers, and Attitudes for Palliative Care in the Emergency Department George, N., Wallingford, G., Rosenthal, M., Neugarten, C. J., Ouchi, K., Jubanyik, K., Manfredi, R. A., Crandall, C., Fullerton, L. ELSEVIER SCIENCE INC. 2023: E662

  View details for Web of Science ID 001006227200279

• Embedding Palliative Care Clinicians into the ED: A Case Study Baldeo, R., Neugarten, C. J., Tan, A., DeSandre, P. L., Goett, R. ELSEVIER SCIENCE INC. 2023: E654

  View details for Web of Science ID 001006227200265

• Upstreaming Palliative Care: Emergency Department Opportunities DeSandre, P. L., Tan, A., Goett, R., Baldeo, R., Neugarten, C. ELSEVIER SCIENCE INC. 2023: E263-E264

  View details for Web of Science ID 001038555400038

• The value of embedded palliative care in the emergency department ACADEMIC EMERGENCY MEDICINE Neugarten, C., Baldeo, R., Tian, K., Piscitello, G., O'Mahony, S., Kaginele, P., Wang, D. H. 2023; 30 (8): 870-873

  View details for DOI 10.1111/acem.14684

  View details for Web of Science ID 000941083300001

  View details for PubMedID 36757676

• Emergency Department Clinician Experience with Embedded Palliative Care JOURNAL OF PALLIATIVE MEDICINE Neugarten, C., Stanley, M., Erickson, S., Baldeo, R., Aaronson, E. 2023; 26 (2): 191-198

  Abstract

  Background: While the benefits of embedding palliative care (PC) clinicians into the emergency department (ED) are now more widely appreciated, only a handful of programs have been reported in the literature. None has previously evaluated the attitudes and experiences of the multidisciplinary ED team with such an intervention. Objectives: We evaluated the experience of ED attendings, residents, nurses, social workers, and chaplains with an embedded PC clinician in the ED. Design/Subjects: We embedded PC clinicians into an urban, academic ED in the United States and surveyed 142 ED clinicians about their experiences. We analyzed survey results using descriptive analysis for closed-ended responses and thematic analyses for open-ended responses. Measurements/Results: One hundred six of 141 clinicians responded (75% response rate). Quantitative analysis found that 99% of participants found the program valuable. Benefits of embedded PC included changing patients' management or care trajectory, freeing up ED providers for other tasks, contributing to provider education, helping providers feel more supported during their shifts, and adding to providers' skill sets and confidence in practicing primary PC. Most participants reported minimal barriers to engaging with PC. The qualitative analysis identified program approval, desire for expansion/continuation of the program, and ongoing education of ED staff. Important themes for future programs include staff education, PC proactivity, importance of adapting to the needs of the ED, and education regarding PC consultation criteria. Conclusions: ED clinicians' attitudes toward embedded PC reflected overall approval, with underlying themes of providers feeling more supported during their shifts, improved resource management, the perception of better patient care, and nursing empowerment.

  View details for DOI 10.1089/jpm.2022.0106

  View details for Web of Science ID 000859011800001

  View details for PubMedID 36074083

• Expanding into the Emergency Department: Exploring Primary Palliative Care Initiatives Versus Embedded Palliative Care Programs Tan, A., Goett, R., DeSandre, P., Neugarten, C., Baldeo, R. ELSEVIER SCIENCE INC. 2022: 802-803

  View details for Web of Science ID 000812783700054

• Use of Telemedicine to Expedite and Expand Care During COVID-19 WESTERN JOURNAL OF EMERGENCY MEDICINE Shah, M., Patel, K., Popa, D., Perry, A., Adams, S., Hexom, B., Neugarten, C., Gottlieb, M. 2021; 22 (5): 1028-1031

  Abstract

  The novel coronavirus disease 2019 (COVID-19) created challenges with access to care including increased burden on healthcare systems and potential exposure risks for vulnerable patients. To address these needs, Rush University Medical Center created a virtual, urgent care program specifically designed to address these challenges during the COVID-19 pandemic.This was a retrospective study analyzing adult patients with COVID-19-related telemedicine visits performed between March 1-June 30, 2020. COVID-19-related telemedicine visits refer to those who used the "Concern for Coronavirus" module. We assessed the total number of telemedicine visits using this module, percentage with a subsequent emergency department (ED) visit within seven days, and outcomes (ie, hospitalization status, intubation, and death) of patients who presented to the ED for evaluation. Data are presented using descriptive statistics.A total of 2,974 adult patients accessed the program via the COVID-19 module over the four-month period. Of those, 142 patients (4.8%) had an ED visit within seven days. Only 14 patients (0.5%) required admission. One patient was intubated, and there were no deaths among the telemedicine population.The data suggests that telemedicine may be a safe and effective way to screen and treat patients with possible COVID-19, while reducing potential burdens on EDs.

  View details for DOI 10.5811/westjem.2021.4.51317

  View details for Web of Science ID 000696926300003

  View details for PubMedID 34546876

  View details for PubMedCentralID PMC8463054