Table 1.
Characteristics of the Included Studies
| Study reference | Setting | Methodology | Data collection | Participants | Intervention | Outcomes | Hospital admissions | Length of stay | Impact on symptoms | Impact on HQoL | Use of other health care services | Referrals to palliative care services | NICE SIGN |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Glajchen 2011 | Beth Israel Medical Center, New York, U.S. — large academic medical center with 940 beds and 60,000 annual ED visits | Case series; single center | May – December 2007 | n = 139 (51 referred to PC; 88 not referred); n = 56 male; n = 42 cancer; mean age 79.92–80.59 | Two-stage screening protocol (BriefPal) and training | Referrals to specialist PC; symptoms | Not assessed | Not assessed | n = 112 (follow-up) reported symptom reduction in pain, SOB, nausea, anxiety (no comparison) | Not assessed | Not assessed | At the peak of implementation, the BriefPal project accounted for half of all referrals to PC | NICE 4/8 (+) |
| Lamba 2012 | New Jersey University Hospital, U.S. — academic, urban, level-1 trauma ED (100,000 patient visits/year) | Case series; single center; retrospective review of data | March 2008 to June 2009 | n = 89 ED-PC; n = 52 males; subgroup with mean age at death = 45 years | Two advanced NPs and 2 masters-trained bereavement/family support counselors | Survival, LOS, destination postdischarge | Not assessed | Average hospital LOS = 2 days (0.76 on subgroup that died) | Not assessed | Not assessed | 24% returned to ED within 1 month and 59% within 6 months. N = 4 (4%) discharged to nursing facility | N = 11 (12%) discharged to home hospice | NICE 3/8 (+) |
| Mahony 2008 | Montefiore Medical Center, Bronx, N.Y., U.S. — urban community teaching hospital, 80,000 episodes/year | Case series; single center | April 2005 to June 2006 | n = 291 (847 consultations); females 64%; mean age 79 ± 8.4; N = 61 cancer | Two PC NPs working in the ED 11 a.m. – 9 p.m. Monday through Friday | Hospital admission, QoL, destination postdischarge, ED use, survival | 90% of patients enrolled were admitted to the medical center | Not assessed | Not assessed | MVQoL scale (n = 20); 14 = satisfaction with control of their physical symptoms; 13 = “loss of ability to do many of the things that I like” | N = 131 (45%) visited ED in the 12 months postdischarge; N = 110 (41.9% from all admissions) discharged to skilled nursing facilities | n = 83 received homecare and N = 91 hospice; correlations between referral to ED PC and enrollment on hospice (r = 0.49, p < 0.001) | NICE 3/8 (+) |
| Van Tricht 2012 | 174 EDs, both urban and rural (171 in France and 3 in Belgium); mainly university hospitals; all with PC mobile units | Retrospective cohort; multicenter; compared patients who received ED PC vs standard care | November –December 2004 and April – May 2005 | n = 2420; mean age 73 ± 15.1; 1196 male; n = 1373 received PC (exposed); n = 1047 standard care (unexposed) | ED-PC services: analgesia, sedation, hydration, mouth care, reposition, emotional support | Survival, LOS, withhold/withdraw life support, time from admission to death | Not assessed | ED-based PC associated with interval between admission and death longer than 9 hours OR (95% CI) 2.75 (2.21–3.41) p < 0.001 | Not assessed | Not assessed | Not assessed | Not assessed | SIGN 4/13 (0) |
| Wu 2013 | California Pacific Medical Center, U.S.; 2 centers (18,000 and 28,000 annual ED visits) | Retrospective cohort with control group; multicenter | January 2006 to December 2010 | n = 1435 (215 Davies and 1220 Pacific) control; n = 1385; intervention n = 50; mean age 75.6; N = 768 female | ED-based PC service consisting of 2 physicians and an NP | LOS, average time to PC consultation | 90-day readmission; 11/50 patients (22%) ED-based PC vs 179/1385 (13%) that received standard care | Mean LOS intervention (n = 50) = 4.32 days (SE 0.68, p < 0.01); control (n = 1385) = 8.29 days (SE 0.36, p < 0.01) | Not assessed | Not assessed | Not assessed | Not assessed | SIGN 10/13 (++) (downgraded to +; see text) |
ED, emergency department; HQoL, health quality of life; LOS, length of stay; NICE, National Institute for Health and Care Excellence; MVQoL, Missoula Vitas Quality of Life; NP, nurse practitioner; OR, odds ratio; PC, palliative care; QOL, quality of life; SE, standard error; SIGN, Scottish Intercollegiate Guidelines Network; SOB, shortness of breath.