The Effectiveness of Emergency Department-Based Interventions for Patients with Advanced or End-Stage Illness: A Systematic Review
Supervisor / Principle Investigator:
Scott W. Kirkland
Brian H. Rowe
MD Class of 2021
Introduction: An increasing number of patients in need of end of life (EoL) care are presenting to emergency departments (EDs) for help managing acute exacerbations of their symptoms. The ED, however, is ill-equipped to manage these patients in need of palliative care (PC) and there is a need to systematically summarize ED-based PC interventions to improve patient outcomes.
Hypothesis: To identify and examine the effectiveness of ED-based PC interventions at improving health outcomes among patients with EoL needs.
Methods: A comprehensive search of nine electronic databases and grey literature sources was conducted to identify any comparative studies assessing the effectiveness of ED-based PC interventions to improve health outcomes of patients with EoL needs. Two independent reviewers completed study selection, quality assessment, and data extraction. Differences were mediated via third-party adjudication. Relative risks (RR) with 95% confidence intervals (CIs) was calculated using a random effects model.
Results: From 5882 potentially eligible citations, the full text of 83 studies were reviewed. Twelve studies were included, in which two clinical trials were currently on-going. As a result, 10 studies will be included in the analysis. The studies consisted of four RCTs, five before-after studies, and one observational cohort study. Interventions assessed among the included studies consisted primarily of ED-based PC consultations, while other studies assessed improved screening for patients with EoL needs, and ED-staff palliative education. Data analysis is currently on-going.
Conclusions: This review identified 12 studies examining the effectiveness of ED-based PC interventions. The results of this review are expected to inform possible directions for ED-based PC interventions to improve outcomes for patients with EoL care gaps.