The following is a summary of “Association between advanced care planning and emergency department visits: A systematic review,” published in the June 2023 issue of Pediatrics by Sakamoto, et al.
Advance care planning (ACP) involves patient-centered discussions about end-of-life care preferences, aiming to align medical interventions with individual wishes and potentially reducing avoidable emergency department (ED) transfers. However, uncertainties persisted regarding the impact of ACP on ED visits and ambulance calls, particularly across various contexts and patient conditions. For a systematic review, researchers sought to evaluate the potential influence of advanced care planning on the frequency of emergency department visits and ambulance calls.
The study methodology adheres to a systematic review framework and is registered in PROSPERO. RoB 2.0, ROBINS-I, and ROBINS-E tools were employed to assess bias. A comprehensive search encompassed the PubMed, Cochrane CENTRAL, and EMBASE databases from their inception to September 22, 2022. The focus was on studies that compared patients with and without advanced care planning with reported emergency department visits and ambulance call outcomes.
Eight relevant studies were identified. Within nursing home settings, two studies demonstrated a statistically significant reduction in emergency department visits and ambulance calls due to advanced care planning interventions. Conversely, two studies conducted across multiple medical care facilities yielded inconclusive findings. Regarding specific patient conditions, the implementation of ACP showed promise in diminishing emergency department visits among patients diagnosed with depression or dementia. However, studies involving severe respiratory diseases and serious illnesses revealed no significant reduction in ED visits. The majority of the included studies exhibited a high risk of bias.
The evidence suggests that advanced care planning may positively impact diminishing emergency department visits and ambulance calls for nursing home residents and individuals with depression or dementia. Nevertheless, a further comprehensive investigation was necessary to establish the efficacy of ACP in various healthcare contexts and diverse patient conditions.