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  • Effects of 24/7 palliative care consultation availability on the use of emergency department and emergency medical services resources from non-oncological patients: a before-and-after observational cohort study

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Original research
Effects of 24/7 palliative care consultation availability on the use of emergency department and emergency medical services resources from non-oncological patients: a before-and-after observational cohort study
  1. Danila Valenti1,
  2. Lorenzo Gamberini2,
  3. Davide Allegri3,
  4. Marco Tartaglione2,
  5. Fabrizio Moggia1,
  6. Donatella Del Giudice4,
  7. Raffaella Baroni5,
  8. Cristian Vincenzo Francesco Di Mirto1,
  9. Jacopo Tamanti1,
  10. Silvia Rosa1,
  11. Serena Paoletti1,
  12. Luigi Bruno1,
  13. Chiara Peterle1,
  14. Anna Maria Rita Cuomo1,
  15. Alessio Bertini6,
  16. Fabrizio Giostra7 and
  17. Francesca Mengoli1
  18. Collaborators
    1. 1Palliative Care Network, AUSL di Bologna, Bologna, Italy
    2. 2Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
    3. 3Department of Clinical Governance and Quality, AUSL di Bologna, Bologna, Italy
    4. 4EMS 118 Regional Programme, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
    5. 5Management Staff - Business Information Systems, AUSL di Bologna, Bologna, Italy
    6. 6Emergency Medicine, Emergency Department, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
    7. 7Emergency Medicine, Emergency Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
    1. Correspondence to Dr Lorenzo Gamberini, Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna 40133, Italy; lorenzo.gamberini86{at}gmail.com

    Abstract

    Objectives The non-oncological population is relatively under-represented among end-of-life (EOL) patients managed by palliative care (PC) services, and the effects of different PC delivery models are understudied in this population.

    This retrospective observational study on routinely collected data aimed at evaluating the effects of the extension from workday-only to 24/7 mixed hands-on and advisory home PC service on emergency department (ED) access and emergency medical services (EMS) interventions needed by non-oncological patients during their last 90 days of life, and their probability to die in hospital.

    Methods A before-and-after design was adopted comparing preimplementation and postimplementation periods (2018–2019 and 2021–22).

    We used a difference-in-differences approach to estimate changes in ED access and EMS intervention rates in the postintervention period through binomial negative regression. The oncological population, always exposed to 24/7 PC, was used as a control. A robust Poisson regression model was adopted to investigate the differences regarding hospital mortality. The analyses were adjusted for age, sex and disease grouping by the system involved. Results were reported as incidence rate ratios (IRRs) and ORs.

    Results A total of 2831 patients were enrolled in the final analysis.

    After the implementation of 24/7 home PC, both ED admissions (IRR=0.390, p<0.001) and EMS interventions (IRR=0.413, p<0.001) dropped, as well as the probability to die in hospital (OR=0.321, p<0.001).

    Conclusions The adoption of a 24/7 mixed hands-on and advisory model of home PC could have relevant effects in terms of ED access and EMS use by non-oncological EOL patients under PC.

    Trial regisration number NCT05640076.

    • terminal care
    • chronic conditions
    • home care

    Data availability statement

    Data are available on reasonable request. The anonymised dataset related to this publication is available from the authors on appropriate request.

    http://dx.doi.org/10.1136/spcare-2023-004412

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      Data availability statement

      Data are available on reasonable request. The anonymised dataset related to this publication is available from the authors on appropriate request.

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      Footnotes

      • Twitter @LorenzoGamberi6

      • Collaborators Lisa Manuzzi MD—Palliative Care Network, AUSL di Bologna, Bologna, Italy; Floriana Taggi MD—Palliative Care Network, AUSL di Bologna, Bologna, Italy; Letizia Ronchi MD—Palliative Care Network, AUSL di Bologna, Bologna, Italy; Lapo Bartoli MD—Resident in Family Medicine, Bologna University, Bologna, Italy.

      • Contributors Conceptualisation: DV, FMo and FMe; Methodology: CVFDM, JT, SR and SP. Validation: DDG; DA and RB; Formal analysis: LG and DA; Investigation: LB, CP and AMRC; Data curation: DA, DDG, RB, FMo and LG; Writing—original draft: LG, DA and MT; Writing—review and editing: DV, AB and FG; Visualisation: LG and DA; Supervision: DV. Guarantor: LG.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.