Eliciting Healthcare Goals in the ED

When older adults come to the emergency department (ED), care teams may struggle to capture what matters most to them. The ED environment is fast-paced, and care is often protocol driven, which can make it hard to engage patients in communication about their priorities and clinical decision-making. In the United States, the Centers for Medicare & Medicaid Services (CMS) recently developed an age-friendly hospital measure that requires eliciting patients’ healthcare goals in hospital care. There are many questions that need to be answered: who should do this? How? With whom? In this post, we want to outline some simple considerations for clinicians about asking patients about their healthcare goals.

From “Goals” to “Worries” and “Expectations”

In practice, the language we use matters. Many patients and caregivers do not naturally think about their ED visit in terms of goals. In research and quality improvement, when we have directly asked ED patients about the goal of their visit or the outcome they’re hoping for from the visit, the question has often fallen flat. Instead, asking about their “biggest worry” or “what they expected would happen today” opens the door to meaningful conversation. These simple prompts are often more intuitive for patients and can reveal priorities that shape both communication and care.

In clinical practice and research, we have found that ED patients generally fall into a few buckets of expectations:

• Seeking symptom control (“I just need the pain to stop.”)
• Hoping for a specific diagnosis (“I want to know what’s causing this cough.”)
• Looking for reassurance about a feared condition (“I want to make sure it’s not my heart.”)
• Needing help with care coordination (“I can’t get an appointment with my pulmonologist and I didn’t want to wait four months.”)
• Following a referral (“My cardiologist sent me in,” “My wife made me come in”)

A quick, well-phrased question—such as “What was your biggest worry coming in today?” or “What was your biggest worry about your health today?”—can help clinicians identify the bucket a patient falls into. That insight may not always change medical decision-making, but it can transform the patient’s experience and the clarity of communication.

When knowing patient goals is most helpful

Understanding patient goals or expectations isn’t equally actionable in every situation. Based on feedback we’ve obtained from emergency clinicians, there are three situations where it’s most useful to elicit healthcare goals:

1. When a patient has serious/critical illness (i.e., decisions have to be made about resuscitation, intubation, and intensive care)
2. When there is clinical equipoise around the disposition – and care teams are making decisions about whether an older adult should be admitted or discharged
3. When a patient has a chief complaint or presentation for a concern that doesn’t result in a fairly standard, protocolized approach to their care (e.g., weakness/fatigue—a varied approach vs. chest pain—a protocolized approach)

Bringing Structure to ‘What Matters’

Below is a series of questions that can be adapted for your hospital team as an interview guide for eliciting patients’ goals, i.e., their expectations of ED care. You can download a PDF copy here.

These questions were tested with emergency department patients and are phrased for clarity. The questions are intended to be used by clinicians, social workers, volunteers, or other ancillary personnel.

As noted in the PDF, some of these questions have been adapted from the Patient Priorities Care framework – see patientprioritiescare.org.

Importantly, a patient’s goals and expectations become more meaningful when understood in context—their caregiving situation, social supports, and functional status. These dimensions influence how clinicians can act on what they learn. That’s why the above materials contain a nod to these domains.

Ultimately, eliciting what matters most is not just about compliance with CMS—it’s about connection. Asking older adults about their expectations of the visit can shape the ED encounter into an interaction that honors patients’ priorities and autonomy, even in moments of crisis.