Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits

Abstract

PURPOSE: Did the creation of an urgent care clinic specifically for patients with cancer affect emergency department visits among adults newly diagnosed with cancer? PATIENTS AND METHODS: We applied an interrupted time series analysis to adjusted monthly emergency department visits made by adults age 18 years or older who were diagnosed with cancer between 2009 and 2016 at a comprehensive cancer center. Cancer registry patients were linked to a longitudinal regional database of emergency department and hospital visits. Because the urgent care clinic was closed on weekends, we took advantage of the natural experiment by comparing weekend visits as a control group. Our primary outcome was emergency department visits within 180 days after a cancer diagnosis, compiled as adjusted monthly rates of emergency department visits per 1,000 patient-months. We analyzed subsequent hospitalizations as a secondary outcome. RESULTS: The rate of weekday emergency department visits was increasing at a rate of 0.43 visits (95% CI, 0.29 to 0.57 visits) per month before May 2012, then fell in half to a rate of 0.19 visits (95% CI, 0.11 to 0.28 visits) per month ( P = .007) after the urgent care clinic was established. In contrast, the weekend visit rate was growing at a rate of 0.08 visits (95% CI, −0.03 to 0.19 visits) per month before May 2012 and 0.05 (95% CI, −0.02 to 0.13 visits; P = .533) afterward. By the end of 2016, there were 15.3 fewer monthly weekday emergency department visits than expected ( P = .005). Trends in weekday hospitalizations were not significantly changed. CONCLUSION: Although only one in eight emergency department–visiting patients also used the urgent care clinic, the growth rate of emergency department visits fell by half after the urgent care clinic was established.

Impact of underlying malignancy on emergency department utilization and outcomes

“…Research demonstrates that cancer-specific pathways in general within an ED triage system can improve outcomes in terms of inpatient admission, decreased ED visits, and decreased overall mortality. [27][28][29] Given the variable outcomes among different cancer subtypes our study underscores importance of considering cancer type in the risk stratification process of this uniquely vulnerable patient population.…”

Lien entre la qualité des interventions téléphoniques des infirmières auprès des adultes atteints de cancer et les visites évitables au service des urgences

“…Nos constats illustrent à quel point les visites aux urgences pourraient diminuer si d'autres services dans le système prenaient en charge les patients qui présentent des symptômes de modérés à sévères nécessitant d'urgence une évaluation en personne. Des cliniques de soins d'urgence sont parfois intégrées aux programmes d'oncologie ambulatoire afin d'offrir en semaine des services d'évaluation des patients, des tests de diagnostic (tests de laboratoire, radiographie) et l'administration de médicaments ou de solutés par voie intraveineuse (Hong, Froehlich, Clayton Hobbs, Lee et Halm, 2019;Sedghi et al, 2019). Les études de Hong et collaborateurs et de Sedghi et collaborateurs ont d'ailleurs démontré que l'ouverture de ces cliniques contribuait à faire diminuer le nombre de visites aux urgences.…”

“…Les études de Hong et collaborateurs et de Sedghi et collaborateurs ont d'ailleurs démontré que l'ouverture de ces cliniques contribuait à faire diminuer le nombre de visites aux urgences. Ce nombre ne diminuait pas par contre durant les fins de semaine, les cliniques en question n'ouvrant qu'en semaine (Hong et al, 2019). Ces établissements ne remplacent pas l'accès par téléphone à des infirmières pour les patients cancéreux, mais fournissent une option adaptée à ceux qui présentent des symptômes plus sévères.…”

Using Evidence to Design Cancer Care Facilities

“…21,22 Several hospital systems, including Yale’s Smilow Cancer Hospital and the University of Texas Southwestern Medical Centers, have demonstrated reduced ED visits with implementation of oncology-specific urgent care services. 23,24 Incorporating urgent care into cancer center design has the potential to reduce stressful, expensive ED visits and hospitalizations while addressing patients’ unique, cancer-specific needs.…”