Characteristics of Emergency Department Visits and Select Predictors of Hospitalization for Adults With Newly Diagnosed Cancer in a Safety-Net Health System

Hong, Arthur S.; Sadeghi, Navid; Harvey, Valorie; Lee, Simon J. Craddock; Halm, Ethan A.

doi:10.1200/jop.18.00614

Cited by 15 publications

(28 citation statements)

References 29 publications

(32 reference statements)

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“…Patients with cancer are more likely to be admitted to a progressive care or intensive care unit (11%) compared to the general population (2%) [9,10]. Between 34 and 49% are discharged home [8,10,17] and approximately, 4-5% of the remaining patients are transferred to another facility, die during the ED visits, or leave before physican evaluation or against medical advice [10,48].…”

Section: Estimatesmentioning

confidence: 99%

“…A potential explanation of the underuse of these phone-based triage resources is suggested by qualitative work finding that patients feel guilty for bothering providers [27]. While a common explanation of non-urgent ED use is that other outpatient alternatives were closed, at least two population-based US studies have found that roughly half of ED arrivals occur during business hours [38,48].…”

Section: Health System Factorsmentioning

confidence: 99%

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Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care

et al. 2022

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Background The global prevalence of cancer is rapidly increasing and will increase the acute care needs of patients with cancer, including emergency department (ED) care. Patients with cancer present to the ED across the cancer care continuum from diagnosis through treatment, survivorship, and end-of-life. This article describes the characteristics and determinants of ED visits, as well as challenges in the effort to define preventable ED visits in this population. Findings The most recent population-based estimates suggest 4% of all ED visits are cancer-related and roughly two thirds of these ED visits result in hospitalization—a 4-fold higher ED hospitalization rate than the general population. Approximately 44% of cancer patients visit the ED within 1 year of diagnosis, and more often have repeat ED visits within a short time frame, though there is substantial variability across cancer types. Similar patterns of cancer-related ED use are observed internationally across a range of different national payment and health system settings. ED use for patients with cancer likely reflects a complex interaction of individual and contextual factors—including provider behavior, health system characteristics, and health policies—that warrants greater attention in the literature. Conclusions Given the amount and complexity of cancer care delivered in the emergency setting, future research is recommended to examine specific symptoms associated with cancer-related ED visits, the contextual determinants of ED use, and definitions of preventable ED use specific to patients with cancer.

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Section: Estimatesmentioning

confidence: 99%

Section: Health System Factorsmentioning

confidence: 99%

Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care

et al. 2022

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“…This is similar to findings from other countries. [12][13][14] Management plans for all these symptoms can be initiated and instituted at EDs, especially for haemodynamically stable patients, and can potentially be relieved within several hours. ED observations units would have the resources to manage such complaints.…”

Section: Discussionmentioning

confidence: 99%

“…10 Several international studies have described characteristics of cancer-related acute healthcare use, with infections and poorly controlled symptoms being key drivers of ED visits and subsequent hospital admissions. [11][12][13][14] In Singapore, limited…”

Section: Introductionmentioning

confidence: 99%

Characteristics of unplanned hospitalisations among cancer patients in Singapore

Zhuang

Chan

See

et al. 2021

Ann Acad Med Singap

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Introduction: Cancer is a pervasive global problem with significant healthcare utilisation and cost. Emergency departments (EDs) see large numbers of patients with oncologic emergencies and act as “gate-keepers” to subsequent hospital admissions. A proportion of such hospital admissions are rapidly discharged within 2 days and may be potentially avoidable. Methods: Over a 6-month period, we conducted a retrospective audit of active cancer patients presenting to the ED with subsequent admission to the Department of Medical Oncology. Our aims were to identify independent factors associated with a length of stay ≤2 days; and characterise the clinical and resource needs of these short admissions. Results: Among all medical oncology admissions, 24.4% were discharged within 2 days. Compared to longer stayers, patients with short admissions were significantly younger (P=0.010), had lower National Early Warning Scores (NEWS) (P=0.006), and had a lower proportion of gastrointestinal and hepatobiliary cancers (P=0.005). Among short admissions, common presenting medical problems were infections (n=144, 36.3%), pain (n=116, 29.2%), gastrointestinal complaints (n=85, 21.4%) and respiratory complaints (n=76, 19.1%). These admissions required investigations and treatments already available at the ED. Conclusion: Short admissions have low resource needs and may be managed in the ED. This may help save valuable inpatient bed-days and reduce overall healthcare costs. Keywords: Emergency medicine, healthcare use, oncology, palliative care, unplanned cancer admission

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“…These toxicities commonly lead to high healthcare utilization, including frequent emergency department (ED) visits and prolonged hospitalizations, which contribute to the rising costs of cancer care, impaired patient quality of life (QOL), and morbidity related to treatment [ 1 – 16 ]. Notably, patients with advanced cancer experience multiple ED visits during the first year of diagnosis, with over half of these visits resulting in an inpatient hospitalization [ 4 – 6 , 17 ]. Moreover, over 40% of hospitalized patients with advanced cancer have a hospital readmission within 90 days of discharge and a substantial proportion of these hospitalizations are potentially avoidable [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Supportive oncology care at home interventions: protocols for clinical trials to shift the paradigm of care for patients with cancer

Nipp

Shulman²,

Smith³

et al. 2022

BMC Cancer

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Background Patients with cancer often endure substantial symptoms and treatment toxicities leading to high healthcare utilization, including hospitalizations and emergency department visits, throughout the continuum of their illness. Innovative oncology care models are needed to improve patient outcomes and reduce their healthcare utilization. Using a novel hospital at home care platform, we developed a Supportive Oncology Care at Home intervention to address the needs of patients with cancer. Methods We are conducting three trials to delineate the role of Supportive Oncology Care at Home for patients with cancer. The Supportive Oncology Care at Home intervention includes: (1) a hospital at home care model for symptom assessment and management; (2) remote monitoring of daily patient-reported symptoms, vital signs, and body weight; and (3) structured communication with the oncology team. Our first study is a randomized controlled trial to test the efficacy of Supportive Oncology Care at Home versus standard oncology care for improving healthcare utilization, cancer treatment interruptions, and patient-reported outcomes in patients with cancer receiving definitive treatment of their cancer. Participants include adult patients with gastrointestinal and head and neck cancer, as well as lymphoma, receiving definitive treatment (e.g., treatment with curative intent). The second study is a single-arm trial assessing the feasibility and acceptability of the Supportive Oncology Care at Home intervention for hospitalized patients with advanced cancer. Eligible participants include adult patients with incurable cancer who are admitted with an unplanned hospitalization. The third study is a single-arm trial assessing the feasibility and acceptability of the Supportive Oncology Care at Home intervention to enhance the end-of-life care for patients with advanced hematologic malignancies. Eligible participants include adult patients with relapsed or refractory hematologic malignancy receiving palliative therapy or supportive care alone. Discussion These studies are approved by the Dana-Farber/Harvard Cancer Center Institutional Review Board and are being conducted in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials. This work has the potential to transform the paradigm of care for patients with cancer by providing them with the necessary support at home to improve their health outcomes and care delivery. Trial registrations NCT04544046, NCT04637035, NCT04690205.

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Characteristics of Emergency Department Visits and Select Predictors of Hospitalization for Adults With Newly Diagnosed Cancer in a Safety-Net Health System

Cited by 15 publications

References 29 publications

Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care

Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care

Characteristics of unplanned hospitalisations among cancer patients in Singapore

Supportive oncology care at home interventions: protocols for clinical trials to shift the paradigm of care for patients with cancer

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