Association between advanced care planning and emergency department visits: A systematic review

Ayaka Sakamoto; Ryota Inokuchi; Masao Iwagami; Yu Sun; Nanako Tamiya

doi:10.1016/j.ajem.2023.03.004

Association between advanced care planning and emergency department visits: A systematic review

Am J Emerg Med. 2023 Jun:68:84-91. doi: 10.1016/j.ajem.2023.03.004. Epub 2023 Mar 13.

Authors

Ayaka Sakamoto¹, Ryota Inokuchi², Masao Iwagami³, Yu Sun⁴, Nanako Tamiya³

Affiliations

¹ Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan.
² Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan; Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan. Electronic address: inokuchir-icu@md.tsukuba.ac.jp.
³ Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan; Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan.
⁴ Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan; Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan; Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan.

PMID: 36958094
DOI: 10.1016/j.ajem.2023.03.004

Abstract

Background: Advance care planning can help provide optimal medical care according to a patient's wishes as a part of patient-centered discussions on end-of-life care. This can prevent undesired transfers to emergency departments. However, the effects of advance care planning on emergency department visits and ambulance calls in various settings or specific conditions remain unclear.

Aim: To evaluate whether advanced care planning affected the frequency of emergency department visits and ambulance calls.

Design: Systematic review. This study was registered in PROSPERO (CRD42022340109). We assessed risk of bias using RoB 2.0, ROBINS-I, and ROBINS-E.

Data sources: We searched the PubMed, Cochrane CENTRAL, and EMBASE databases from their inception until September 22, 2022 for studies comparing patients with and without advanced care planning and reported the frequency of emergency department visits and ambulance calls as outcomes.

Results: Eight studies were included. Regarding settings, two studies on patients in nursing homes showed that advanced care planning significantly reduced the frequency of emergency department visits and ambulance calls. However, two studies involving several medical care facilities reported inconclusive results. Regarding patient disease, a study on patients with depression or dementia showed that advanced care planning significantly reduced emergency department visits; in contrast, two studies on patients with severe respiratory diseases and serious illnesses showed no significant reduction. Seven studies showed a high risk of bias.

Conclusions: Advanced care planning may lead to reduced emergency department visits and ambulance calls among nursing home residents and patients with depression or dementia. Further research is warranted to identify the effectiveness of advanced care planning in specific settings and diseases.

Keywords: Advanced care planning; Advanced directive; Emergency medical service; Living will; Systematic review.

Publication types

Systematic Review
Review

MeSH terms

Ambulances
Dementia*
Emergency Service, Hospital*
Humans
Nursing Homes