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Rational and Objective Evaluate predictors of Emergency Department (ED) utilization by adult patients receiving hemodialysis (HD) and interventions to reduce ED utilization by HD patients. Study Design We searched Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library for randomized controlled trials and observational studies up until April 2020. Selection Criteria for Studies We included studies that investigated predictors of ED utilization and/or interventions to reduce ED utilization in HD patients. Data Extraction We extracted data regarding study design, study population, and results regarding ED utilization from 38 studies using Excel software. Analytical Approach We performed narrative synthesis to group articles that investigated similar themes. Results 1060 titles and abstracts were screened, of which 98 were selected for full-text review. 38 studies met inclusion criteria and underwent data extraction. Quality was high according to the Downs and Black tool, with 11 rated as good, 22 as fair, and 5 as poor. 34 studies described predictors of ED utilization, while 4 studies investigated interventions where ED utilization was studied. Our narrative synthesis produced 8 concept subgroups in the core concepts of access to care, comorbidity burden, and new healthcare models. Poor access to care and high comorbidity burden are associated with increased ED use. No ED-based interventions designed to reduce ED utilization were identified, but recent changes in healthcare systems like the formation of ESRD Seamless Care Organizations (ESCOs) and greater involvement of palliative care services are associated with improved outcomes. Limitations Clinical heterogeneity and variability in the included studies precluded a meta-analysis. Conclusions HD patients' high ED use is multifactorial. Further research is required to understand and predict ED utilization in this vulnerable population, which will facilitate the development of interventions to reduce avoidable ED use. |
