Kwadwo Kyeremanteng1, Louis-Philippe Gagnon1, Kednapa Thavorn2,3,4, Daren Heyland5, Gianni D'Egidio1. 1. 1 Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 2. 2 Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada. 3. 3 School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada. 4. 4 Institute of Clinical and Evaluative Sciences, Toronto, Ontario, Canada. 5. 5 Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Abstract
INTRODUCTION: The intensive care unit (ICU) consumes 20% of hospital expenditures and 1% of gross domestic product. Many strategies have been attempted to reduce ICU costs. A systematic review was conducted to evaluate the effect of palliative care (PC) consultations in the ICU on length of stay (LOS) and costs. METHODS: A literature search was performed using PubMed, MEDLINE, EMBASE, and the Cochrane Library. Randomized controlled trials (RCTs), prospective, and retrospective cohort studies looking at PC consultations in adult ICUs published between January 2000 and February 2016 were selected. Independent reviewers assessed the eligibility of studies, extracted data on ICU, hospital LOS, and mortality, and rated each study's quality. The cost was derived from an existing model in the literature; the primary outcome was ICU LOS and the secondary outcomes were direct variable costs, mortality, and hospital LOS. RESULTS: We reviewed 814 abstracts, but only 8 studies met inclusion criteria and were included. The patients with a PC consultation in the ICU, when compared to those who did not, showed a trend toward reduced LOS. This reduction was statistically significant in the higher quality studies. Mortality was similar in both groups. Palliative care consultations also lead to a reduction in costs in 5 of the 8 eligible trials. On average, ICU costs were USD7533 and USD6406 (control vs PC, P < .05) and hospital direct variable costs were USD9518 and USD8971 ( P < .05) per admission. Due to interstudy heterogeneity, all outcomes were described narratively. CONCLUSION: This review demonstrates a trend that PC consultations reduce LOS and costs without impacting mortality. However, due to the small sample sizes and varying degrees of quality of evidence, many questions remain. A large multicenter RCT and formal economic evaluation would be needed for more definitive results.
INTRODUCTION: The intensive care unit (ICU) consumes 20% of hospital expenditures and 1% of gross domestic product. Many strategies have been attempted to reduce ICU costs. A systematic review was conducted to evaluate the effect of palliative care (PC) consultations in the ICU on length of stay (LOS) and costs. METHODS: A literature search was performed using PubMed, MEDLINE, EMBASE, and the Cochrane Library. Randomized controlled trials (RCTs), prospective, and retrospective cohort studies looking at PC consultations in adult ICUs published between January 2000 and February 2016 were selected. Independent reviewers assessed the eligibility of studies, extracted data on ICU, hospital LOS, and mortality, and rated each study's quality. The cost was derived from an existing model in the literature; the primary outcome was ICU LOS and the secondary outcomes were direct variable costs, mortality, and hospital LOS. RESULTS: We reviewed 814 abstracts, but only 8 studies met inclusion criteria and were included. The patients with a PC consultation in the ICU, when compared to those who did not, showed a trend toward reduced LOS. This reduction was statistically significant in the higher quality studies. Mortality was similar in both groups. Palliative care consultations also lead to a reduction in costs in 5 of the 8 eligible trials. On average, ICU costs were USD7533 and USD6406 (control vs PC, P < .05) and hospital direct variable costs were USD9518 and USD8971 ( P < .05) per admission. Due to interstudy heterogeneity, all outcomes were described narratively. CONCLUSION: This review demonstrates a trend that PC consultations reduce LOS and costs without impacting mortality. However, due to the small sample sizes and varying degrees of quality of evidence, many questions remain. A large multicenter RCT and formal economic evaluation would be needed for more definitive results.
Entities:
Keywords:
cost evaluation; intensive care unit; length of stay; palliative care
Authors: Claudia Dziegielewski; Charlenn Skead; Toros Canturk; Colleen Webber; Shannon M Fernando; Laura H Thompson; Madison Foster; Vanja Ristovic; Peter G Lawlor; Dipayan Chaudhuri; Chintan Dave; Brent Herritt; Shirley H Bush; Salmaan Kanji; Peter Tanuseputro; Kednapa Thavorn; Erin Rosenberg; Kwadwo Kyeremanteng Journal: Crit Care Res Pract Date: 2021-04-24
Authors: Peter M Reardon; Shannon M Fernando; Sasha Van Katwyk; Kednapa Thavorn; Daniel Kobewka; Peter Tanuseputro; Erin Rosenberg; Cynthia Wan; Brandi Vanderspank-Wright; Dalibor Kubelik; Rose Anne Devlin; Christopher Klinger; Kwadwo Kyeremanteng Journal: Crit Care Res Pract Date: 2018-09-02
Authors: Claudia Dziegielewski; Robert Talarico; Haris Imsirovic; Danial Qureshi; Yasmeen Choudhri; Peter Tanuseputro; Laura H Thompson; Kwadwo Kyeremanteng Journal: BMC Health Serv Res Date: 2021-12-06 Impact factor: 2.655