Advance care planning and palliative care interventions lead to a reduction in intensive care unit (ICU) admissions and reduced ICU length of stay

Khandelwal N, Kross EK, Engelberg RA, et al.  Estimating the effect of palliative care interventions and advance care planning on ICU utilization: A systematic review  Critical Care Medicine. 2015 May;43(5):1102-11.

Review question

Do advance care planning and palliative care consultations lead to reduced intensive care unit (ICU) admissions and reduced ICU length of stay for patients at high risk of death?

Background

Many patients do not adequately plan for end-of-life treatment or communicate their preferences to healthcare professionals.

Without this planning, patients at high risk of death may receive unwanted intensive care at the end of life instead of alternative options such as palliative care. This situation can be expensive and place a significant burden on healthcare resources.

Advance care planning and palliative care consultations are a promising means of helping patients clarify their values and preferences for end-of-life care, and may also lower ICU admissions and length of stay.    

How the review was done

A detailed electronic search was conducted for studies published from 1995 to March 2014, and those reporting on the effect of advance care planning and palliative care interventions on ICU admissions and ICU length of stay were included.

A total of 172 unique studies were identified in searches, and 13 were included in the review after assessments for eligibility.

This review was funded by the National Institutes of Health (United States).

What the researchers found

The review found that advanced care planning and palliative care interventions consistently reduced the likelihood of patients entering an ICU by an average of 37%.  

General palliative care interventions delivered to patients who are already in an ICU were also found to reduce length of stay in ICUs by 26% on average, which increased to a 33% reduction when targeted at specific individuals.

Conclusion

This review found that advanced care planning and palliative care consulting reduced the likelihood of patients entering an ICU, while palliative care consulting delivered in the ICU was effective at reducing length of stay. Given the results, advanced care planning and palliative care consultations can also potentially lead to significant cost savings while respecting individual patient values. 

This summary is based on a review that was determined to be of medium methodological quality based on an assessment using the AMSTAR tool.