Hospice and palliative care improve quality of life for patients with advanced illness, yet referrals from emergency departments (EDs) remain limited. This study aimed to establish a baseline rate of ED-initiated referrals from the Northwell’s Long Island Jewish Medical Center to its Health’s Hospice and Palliative Care Program between August and December 2024. Using an institutional database, we reviewed 262 referrals and identified referral sources, documentation of ED goals-of-care (GOC) discussions, and patient disposition. Only 5.3% of all palliative care referrals and 3.0% of actual hospice placement referrals originated from the ED, with a decline in ED GOC discussions over the study period. Nearly all referred patients were admitted or placed in observation rather than discharged home or directly to hospice. Persistent cultural, educational, and workflow barriers may limit integration of palliative care within the ED. Improved interdisciplinary communication, provider training, and structured ED-to-hospice pathways may increase appropriate referrals, reduce unnecessary hospitalizations, and promote goal-concordant end-of-life care. Establishing this baseline provides a foundation for future quality improvement initiatives aimed at enhancing patient-centered outcomes for Northwell patients with advanced illness.

Introduction Trauma remains a leading cause of morbidity and mortality in the United States and places a substantial economic burden on the healthcare system. Although simulation-based training has been associated with improved trauma team performance and patient outcomes, whether emergency medicine simulation fellowship programs are associated with differences in trauma mortality remains unknown. This study examined whether counties with emergency medicine simulation fellowship programs differ in trauma mortality rates compared with counties without such programs. Methods County-level trauma mortality data (2021–2023) were obtained from the CDC WONDER Multiple Cause of Death database. The database was queried by county, year, and external cause of death. Trauma-related deaths were identified using ICD-10 external cause-of-death codes corresponding to blunt and penetrating injuries, excluding suicide. Counties with emergency medicine simulation fellowship programs were identified through publicly-available fellowship directories and classified according to the presence or absence of a simulation fellowship program. Trauma mortality rates were calculated by dividing the total number of trauma-related deaths by the cumulative county population for counties with and without simulation fellowship programs. The two mortality rates were compared using the rate ratio, 95% confidence interval, and P value calculated with the MedCalc online statistical calculator. Results Trauma mortality was 8.0 per 100,000 population in counties with emergency medicine simulation fellowship programs compared with 3.3 per 100,000 population in counties without fellowship programs (rate ratio, 2.45; P<0.0001). Conclusion Contrary to our hypothesis, counties with emergency medicine simulation fellowship programs demonstrated higher trauma mortality rates. Because these programs are predominantly located in urban counties, these findings may reflect greater injury severity and higher emergency department volume rather than effects of the fellowship programs themselves. These factors should be considered when interpreting the association between emergency medicine simulation fellowship programs and trauma-related mortality.