Research/Projects

Project Team: Eleanor Reid, Ephrem Abathun

The estimated gap in Ethiopia between need for palliative care and access is over 95%. The critical absence of palliative care results in pain and suffering, as well as significant costs that are absorbed by the individual and family, often result in medical impoverishment and function as a catalyst in the poverty cycle. The goal of this project is to establish the feasibility of an innovative, scalable strategy to integrate palliative care (PC) into communities in Ethiopia by training community health workers in basic palliative care principles and linking them to Hospice Ethiopia.

This project is based on prior research and collaboration with Hospice Ethiopia, including a needs assessment (PMID: 29425055), seminal demonstration of the clinical efficacy of PC in this population with cost-effectiveness analysis (PMID: 36414402), and potential role for PC as a poverty-reduction strategy (PMID: 30274970; PMID: 36962095).

This study is funded by a Spark Award from the Yale Institute of Global Health to Dr. Reid.

Project Team: Eleanor Reid, Dimitris Tsiftsis, Andrew Ulrich, Sarah Aly, Tushara Surapeneni

Greece is a developed country with a high-income economy, a population of over 10 million, three times that many tourist visits per year, and approximately 150,000 refugees fleeing conflict in the Middle East, but underdeveloped Emergency Medicine. The resulting downstream negative effects span the domains of access to care, quality of care, efficiency of the healthcare system and costs.

We are working on projects to model ideal staffing for Greek Emergency Departments, better understand emergency care capacity in the Aegean through GIS, identify strategies to improve access to palliative care, and amplify the voices of those practicing medicine in Greek Emergency Departments.

Project Team: Bea Sanchez-Rodriguez, Eleanor Reid

Emergency Department healthcare workers care for patients with a variety of disease processes and a range of illness severity. Palliative care offers patient-centered care for patients with incurable disease. An analysis of end-of-life care in Peru indicates that 75% of elderly persons visited the ED within 6 months of their death and 51% during the month preceding their death. This suggests that there is a clear population near end of life that visits the ED and can likely benefit of palliative care. In Peru there is a gap in availability of palliative care for those emergency patients who need it. In addition, in Peru there is no legal basis for advance directives that are not notarized which can complicate medical decision making. This study therefore aims to identify palliative care needs and barriers in the EDs of two public hospitals in Lima, Peru.

The study is funded by an NIH-Fogarty Award to Dr. Sanchez-Rodriguez.

Project Team: Bea Sanchez-Rodriguez, Eleanor Reid, Sarah Aly, Jorge Zaldivar

Globally, healthcare providers in Emergency Departments care for patients with a myriad of disease processes and a range of illness severity. In fragile health systems, this includes a larger percentage of patients with advanced disease and thus palliative care needs due to a combination of factors including lack of screening programs, later presentation of disease processes and fewer available treatment options. Radically, the ED provides an ideal place to start early palliative care and connect patients with inpatient or outpatient services. Palliative care focuses on relieving serious health-related suffering, be it physical, psychological, social, or spiritual. Unlike hospice care, PC is not only directed towards patients at the end of their lives; patients receiving treatment for or diagnosed with serious illness can also benefit from PC.

Palliative Care in Puerto Rico is in its infancy, with no post graduate training programs on the island, lack of incorporation into the public health system and just one small non-profit organization delivering palliative care. The critical absence of palliative care results in pain and suffering, as well as significant costs that are absorbed by patients, families and the healthcare system.

This project is focused on improving emergency palliative care through a variety of mechanisms including development of the IPOS palliative care survey tool including Spanish translation, holding discussion groups with palliative care experts and conducting a survey in academic and community settings to better understand context and to define patient recruitment strategies.

Project Team: Eleanor Reid, Mary Ellen Lyon, Joseph Kalanzi, Anand Selvam

Emergency Medicine is in its infancy in Uganda, with the first Master of Medicine in Emergency Medicine taking place at the Mbarara University of Science and Technology and Makerere University School of Medicine. We are working to support the Makerere program through clinical rotations, didactics, and helping to establish Emergency Medicine research infrastructure through research mentorship and support.

Project Team: Eleanor Reid, Caroline Raymond-King, Beth Liebhardt, Andrew Ulrich

Traumatic deaths are unexpected and sometimes involve interpersonal violence. Families are typically unprepared to receive bad news given the unpredictability of trauma. Family members may experience a range of emotions, and on rare occasions, may react violently, including towards the clinicians disclosing bad news. This low-frequency event can carry significant risks for healthcare workers and bystanders, including the possibility of physical harm or psychological trauma. After a traumatic death, both surgeons and emergency physicians may deliver bad news to families, yet there is no shared understanding or common protocols between departments, nor with protective services, about best practices to safely deliver bad news.

The aims of this project are to bring stakeholders from emergency medicine, surgery, and protective services together to:

1. Identify key best practices in communication and delivery of bad news
2. Establish goals for team and patient’s family safety after disclosure of a traumatic death
3. Create simulation curricula for different types of threats to ED healthcare worker safety including active shooter, violence at the time of a traumatic death.