An Assessment of Emergency Department-Based Interventions for Patients with Advanced or End-Stage Illness: A Systematic Review.

Abstract

Background and Objective: With the increase of visits among patients with end-of-life needs, palliative care (PC) interventions delivered in the emergency department (ED) have become increasingly important. The objective of this systematic review was to examine the effectiveness of ED-based PC interventions. Methods: A comprehensive search of the literature was conducted to identify any comparative studies assessing the effectiveness of ED-based PC interventions. Two independent reviewers completed study selection, quality assessment, and data extraction. Relative risks (RR) with 95% confidence intervals (CIs) were calculated using a random effects model and heterogeneity (I2) was reported. Results: A total of 18 unique studies were included. Two studies reported no difference in return visits to the ED (RR\u2009=\u20091.31; 95% CI: 0.73-2.35; I2\u2009=\u200947%). Two randomized trials reported no difference in mortality (RR\u2009=\u20090.89; 95% CI: 0.71-1.13; I2\u2009=\u20090%), while one cohort study reported an increased mortality among patients referred to PC in the ED (RR\u2009=\u20091.89; 95% CI: 1.58-2.27). Overall, six out of eight studies reported a decrease in hospital length of stay (LOS) among patients undergoing an ED-based PC intervention compared with usual care. Conclusions: While there is compelling evidence to suggest that ED-based PC interventions can reduce hospital LOS, the evidence for the impact of these interventions on other outcomes is less robust. More high-quality comparative studies are needed to better understand the overall impact of ED-based PC interventions on improving patient outcomes as well as improving throughput and other quality of service-related outcomes.