End-of-Life Care, Palliative Care Consultation, and Palliative Care Referral in the Emergency Department: A Systematic Review. Journal of pain and symptom management Wilson, J. G., English, D. P., Owyang, C. G., Chimelski, E. A., Grudzen, C. R., Wong, H., Aslakson, R. A. 2019

Abstract

CONTEXT: There is growing interest in providing palliative care (PC) in the emergency department (ED), but relatively little is known about the efficacy of ED-based PC interventions. A 2016 systematic review on this topic found no evidence that ED-based PC interventions affect patient outcomes or healthcare utilization, but new research has emerged since the publication of that review.OBJECTIVE: This systematic review provides a concise summary of current literature addressing the impact of ED-based PC interventions on patient- or family-reported outcomes, healthcare utilization, and survival.METHODS: We searched Pubmed, Embase, Web of Science, Scopus and CINAHL from inception until September 1, 2018 and reviewed references. Eligible articles evaluated the effects of PC interventions in the ED on patient- or family-reported outcomes, healthcare utilization, or survival.RESULTS: We screened 3091 abstracts and 98 full text articles with 13 articles selected for final inclusion. Two articles reported the results of a single RCT, while the remaining 11 studies were descriptive or quasi-experimental cohort studies. Over half of the included articles were published after the previous systematic review on this topic. Populations studied included older adults, patients with advanced malignancy, and ED patients screening positive for unmet palliative care needs. Most interventions involved referral to hospice or PC, or PC provided directly in the ED. Compared to usual care, ED-PC interventions improved quality of life, though this improvement was not observed when comparing ED-PC to inpatient-PC. ED-PC interventions expedited PC consultation; most studies reported a concomitant reduction in hospital length-of-stay and increase in hospice utilization, but some data were conflicting. Short-term mortality rates were high across all studies, but ED-PC interventions did not decrease survival time compared to usual care.CONCLUSION: Existing data support that PC in the ED is feasible, may improve quality of life, and does not appear to affect survival.

View details for DOI 10.1016/j.jpainsymman.2019.09.020

View details for PubMedID 31586580