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 (I 2 ) 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; I 2 = 47%). Two randomized trials reported no difference in mortality (RR = 0.89; 95% CI: 0.71-1.13; I 2 = 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 highquality 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.

Mapping the future for research in emergency medicine palliative care: A research roadmap

“…In the first phase, a work group was assembled to review the current available literature. Given several recent systematic reviews, 19–23 it was determined that a de novo comprehensive scoping review was not necessary and instead this group focused on synthesizing the themes in the literature based on the current systematic reviews and their knowledge of the literature as experts and through an additional database of 5248 citations collected by one of the work group members (RW) for a thematic ontology of EM PC that was under way. This work group met three times to discuss their findings in the literature and through facilitated discussion identified themes.…”

“…In the first phase, a work group was assembled to review the current available literature. Given several recent systematic reviews, [19][20][21][22][23] F I G U R E 1 Results of a search run by a medical librarian in Ovid Medline, Embase.com, and CINAHL in July 2021 to find the quantity of publications per year on the topic of palliative or hospice care in the ED. Conference abstracts were excluded.…”

“…In particular, there is an opportunity to create a more clear understanding of what the unique value imperatives were that drove the rapid increase in ED-PC integration during COVID 12,13,48,85,87,88 and how many of these programs remain relevant after the pandemic recedes. This body of research will build on the limited work that has tried to quantify impact 20,23 and can focus not only on what the models are but also on increasing knowledge around the process for the prioritization of different models, which will help create a way for leaders to match the right models to the right environments and populations. Important domain-specific models should also receive more attention, for example, in observation medicine, prehospital (EMS), and telemedicine.…”

Intranasal Therapy in Palliative Care

“…The term “palliative care patient” most often refers to patients with advanced or metastatic cancer. However, it is worth distinguishing a group of non-cancer diseases that lead to a terminal condition, which include the following, among others: end-stage renal failure, severe liver failure, or progressive and incurable neurological conditions [ 19 ]. Patients at the end-of-life experience similar problems and distressing symptoms.…”

Is palliative care a utopia for older patients with organ failure, dementia or frailty? A qualitative study through the prism of emergency department admission

“…The literature on palliative care in EDs is emerging and the recommendations are modest and very recent (2017-2021) (24)(25)(26)(27). Despite the limited number of studies and the lack of uniformity in the palliative interventions carried out in the ED, they are showing initial positive effects for the patient and the health care system, such as: improvement of the quality of life without reducing it (28), reduction in length of hospital stays (25), reduction in the number of medical examinations (imaging) and costs (29,30).…”