Table 2.
Effects of ED-Based PC Interventions
| Outcomes | Number of participants (studies) | Data | Comments |
|---|---|---|---|
| Hospital admissions | Two studies, n = 1726: Mahony 2008, case series, U.S., n = 291; Wu 2013, retrospective cohort with control group, U.S., n = 1435 | Mahony 2008: 262 patients (90%) that were attended by MMC ED-based PC team ended up admitted to the medical center during the 14-month time data was collected | No comparison (before and after or with a control group) |
| Wu 2013: 90-day readmission rates — 11/50 patients (22%) from intervention group were readmitted versus 179/1385 (13%) from control group | No statistically significant differences | ||
| LOS | Two studies, n = 1524: Lamba 2012, case series, U.S., n = 89; Wu 2013, retrospective cohort with control group, U.S., n = 1435 | Lamba 2012: “Average” (as stated by the authors) hospital LOS of patients to whom an ED-based PC consultation was initiated was 2 days | No comparison (before and after or with a control group); unclear if “average” represents the mean or median, and SD or IQR were not provided |
| Wu 2013: Mean LOS for the intervention group (patients who received ED-based PC consultations; n = 50) was 4.32 days (SE 0.68) compared to 8.29 days (SE 0.36) in the control group (without ED-based PC consultations; n = 1385); in multivariate analysis (controlling for covariates and propensity scores), the initiation of PC at the ED (vs after) | |||
| Symptoms | One study, Glajchen 2011, case series, U.S., n = 139 | Glajchen 2011: Group referred to BriefPal reported “symptom reduction in pain, shortness of breath, nausea, and anxiety” | No comparison; follow-up made to 112 patients via telephone; no information is given about time points, percentages, means/medians, SDs/IQRs, or P values |
| QoL | One study, Mahony 2008, case series, U.S., n = 291 | Mahony 2008: MVQoLI post-ED discharge (20/291 patients, 6.9% response rate): 14 expressed satisfaction with control of their physical symptoms and 13 expressed improved ability to communicate with people close to them | No information was given on the exact time point when the tool was administered after discharge; very low RR |
| Use of other health care services (includes ED readmission) | Two studies, n = 380: Lamba 2012, case series, n = 89; Mahony 2008, case series, n = 291 | Lamba 2012: Subsequent use of ED of patients who received ED-based PC: 24% returned within 1 month and 59% within 6 months; 4/34 patients that received ED-based PC and survived were discharged to skilled nursing facilities (the remaining 30 had gone home (18/34) / home hospice (11/34) / unknown place (1/34) | No comparison (before and after or with a control group) |
| Mahony 2008: ED-based PC services group (n = 291): 45% (n = 131) visited ED in the 12 months subsequent to the index visit; from subgroup admitted (n = 262), 41.9% were subsequently discharged to skilled nursing facilities, 24.2% to home with homecare, and 19.1% were discharged without homecare | No comparison (before and after or with a control group) | ||
| Referrals to PC or hospice care services | Three studies, n = 519: Glajchen 2011, case series, n = 139; Lamba 2012, case series, n = 89; Mahony 2008, case series, n = 291 | Glajchen 2011: At the peak of implementation, the BriefPal project accounted for half of all referrals to in-hospital PC services | No comparison (before and after or with a control group); no information on the usual referral rate |
| Lamba 2012: 11/89 patients (12%) who received ED-based PC consultations were discharged to home hospice | No comparison (before and after or with a control group) | ||
| Mahony 2008: From n = 550 patients referred by the PC team on discharge (total 894 consultations), 83 received homecare after discharge and 91 received hospice services | No comparison (before and after or with a control group) | ||
| Survival | Three studies, n = 3944: Lamba 2012, case series, n = 89; Van Tricht 2012, retrospective cohort, n = 2420; Wu 2013, retrospective cohort, n = 1435 | Lamba 2012: Rates of in-hospital deaths; ED-initiated PC group (n = 89) death rate = 62% (n = 55), compared to 16% ward-initiated PC group (91/583) and 50% ICU-initiated PC group (288/578) | Significance of differences not reported |
| Van Tricht 2012: ED-based PC associated with an interval between ED admission and death longer than 9 hours (adjusted OR 2.75, 95% CI 2.21–3.41, p < 0.0001) | Data adjusted for other variables not reported | ||
| Wu 2013: APRDRG risk of mortality: Control group 2.3% for minor risk (32/2385), 22.5% for moderate risk (311/1385), 50% for major risk (693/1385), 31.8% for extreme risk (441/1385). Intervention: 4% for minor risk (2/50), 24% for moderate risk (12/50), 62% for major risk (31/50), 10% for extreme risk (5/50) (p < 0.01) | All APRDRG ROM and SOI |
APRDRG, All Patient Refined Diagnostic Related Group; ED, emergency department; IQR, interquartile range; LOS, length of stay; MMC, Montefiore Medical Centre; MVQoLI, Missoula Vitas Quality of Life Index; OR, odds ratio; PC, palliative care; QoL, quality of life; ROM, risk of mortality; SD, standard deviation; SE, standard error; SOI, severity of illness.