title: The Impact of Palliative Care Consultation in the ICU on Length of Stay: A Systematic Review and Cost Evaluation.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors: 1 Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors: Kwadwo
authors: K
authors: Kyeremanteng
authors: 1 Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors: Louis-Philippe
authors: LP
authors: Gagnon
authors: 2 Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.|3 School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.|4 Institute of Clinical and Evaluative Sciences, Toronto, Ontario, Canada.
authors: Kednapa
authors: K
authors: Thavorn
authors: 5 Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors: Daren
authors: D
authors: Heyland
authors: 1 Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors: Gianni
authors: G
authors: D'Egidio
mesh_terms: D003365:Costs and Cost Analysis; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000191:economics; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: cost evaluation; intensive care unit; length of stay; palliative care