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An assessment of emergency department-based interventions for patients with advanced or end-stage illness : a systematic review
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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 = 1.31; 95% CI: 0.73–2.35; I2 = 47%). Two randomized trials reported no difference in mortality (RR = 0.89; 95% CI: 0.71–1.13; I2 = 0%), while one cohort study reported an increased mortality among patients referred to PC in the ED (RR = 1.89; 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.
https://www.liebertpub.com/doi/10.1089/jpm.2020.0607
Voir la revue «JOURNAL OF PALLIATIVE MEDICINE, 24»
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