Outcomes of Patients Placed in an Emergency Department Observation Unit of a Comprehensive Cancer Center

Abstract

PURPOSE Emergency department observation units (EDOUs) have been shown to decrease length of stay and improve cost effectiveness. Yet, compared with noncancer patients, patients with cancer are placed in EDOUs less often. In this study, we aimed to describe patients who were placed in a cancer center's EDOU to discern their clinical characteristics and outcomes. METHODS We performed a retrospective observational study that included all patients age 18 years and older who presented to our emergency department (ED) and were placed in the EDOU between March 1, 2019, and February 29, 2020. The patients' electronic medical records were queried for demographics, comorbidities, diagnosis at the time of placement in the EDOU, length of stay, disposition from the EDOU, ED return within 72 hours after discharge from the EDOU, and mortality outcomes at 14 and 30 days. RESULTS A total of 2,461 visits were eligible for analysis. Cancer-related pain was the main reason for observation in more than one quarter of the visits. The median length of stay in the EDOU was approximately 23 hours, and 69.6% of the patients were discharged. The ED return rate for unscheduled visits at 72 hours was 1.9%. The 14- and 30-day mortality rates were significantly higher for patients who were admitted than for those who were discharged (14 days: 1.7% v 0.3%, P < .001; 30 days: 5.9% v 1.8%, P < .001). CONCLUSION Our data suggest that placing patients with cancer in EDOUs is safe, reduces admissions, and reserves hospital resources for patients who can receive the most benefit without compromising care.

Characteristics and Outcomes of Patients with Cancer Pain Placed in an Emergency Department Observation Unit

“…The low ED revisit and mortality rates in patients discharged from this EDOU after presenting with pain align with the overall low rate of adverse events experienced by all patients discharged from this EDOU. Interestingly, in a prior study, the ED revisit rate for patients discharged from this EDOU regardless of chief complaint was lower than that of patients discharged from its associated ED [ 13 ]. We also found that patients admitted to the hospital after their cancer pain was managed in an EDOU had a higher mortality rate compared to those who were discharged from the EDOU.…”

Emergency department use by patients who received chimeric antigen receptor T cell infusion therapy

“…This unit is functional 24-hours a day and is staffed by an emergency or internal medicine physician along with advanced practice providers. Most patients who are placed in the observation unit originate from the ED; however, patients may also come directly from clinics or procedure areas (9). Additionally, patients may also be admitted directly to the hospital by their oncologists, while bypassing the ED.…”

Psychological Evaluation of Patients With Cancer Presenting to the Emergency Department With Pain: Independent Predictors of Worse Pain Severity, Interference, and Higher Hourly Opioid Administration

“…13 The inability to effectively manage pain worsens patients' quality of life and leads to greater health care utilization, especially emergency department (ED) visits. 5,14,15…”

“…13 The inability to effectively manage pain worsens patients' quality of life and leads to greater health care utilization, especially emergency department (ED) visits. 5,14,15 Almost half of patients with cancer visit the ED at least once within the first year after diagnosis, 16 and patients with cancer account for nearly four million annual ED visits in the United States. 17 Patients often present to the ED with symptoms (eg, pain, nausea/vomiting, and respiratory distress) or complications from cancer treatment (eg, neutropenia) or progression.…”