A hybrid model of acute unscheduled cancer care provided by a hospital-based acute care clinic and the emergency department: a descriptive study

Abstract

Purpose Patients with cancer often experience medical events that require immediate evaluation. These evaluations typically occur in an emergency department (ED), but there is increasing interest in providing this care in other settings. We report on a novel care model whereby a nursing hotline is used to triage patients to the ED or to the North Carolina Cancer Hospital Infusion Center (NCCHIC). Methods A retrospective study of adult patients with a neoplasm diagnosis seeking acute care at a large academic hospital pre-and post-initiation of the novel care model in January of 2016. Patients were identified by querying the electronic medical record and clinic administrative data during matched 6 month pre-and post-periods. Results During the pre-initiation period, 1346 patients visited the ED on 1651 occasions (76.1% admission rate). In the post-initiation period, 1434 patients visited the ED on 1797 occasions (81.5% admission rate), and 246 patients visited the NCCHIC on 322 occasions (68.9% admission rate). The emergency severity index (ESI) in the pre-initiation ED group was primarily ESI 2 (30.6%) and ESI 3 (65.4%). In the post-initiation ED group, the ESI was similar (32.6% ESI 2 and 64.2% ESI 3). In contrast, the NCCHIC predominantly treated lower acuity patients (65.8% calculated ESI of 4/5). Conclusions This model demonstrates a multidisciplinary partnership to providing acute unscheduled care for patients with cancer. In the early implementation phase of this model, approximately 15% of patients, generally of lower acuity, were seen in the NCCHIC.

Chief complaints of patients with cancer who visit the emergency department over their oncologist’s outpatient clinic in South Korea

“…The absence of suitable alternatives other than visiting the ED, as well as the anxiety of patients with cancer about the disease and their psychological desire to seek medical treatment quickly, can be additional factors leading them to visit the ED [4][5][6]15]. While the oncology infusion clinics or acute care clinics can be a good alternative [16], there are difficulties in countries like South Korea, where these clinics are not active. The difficulty of booking an outpatient appointment with their oncologist at a tertiary hospital is associated with the consultation rate of patients.…”

Cancer-related emergency and urgent care: expanding the research agenda

“…Characterize the unmet palliative care or end-of-life needs of cancer patients utilizing emergency care services. 30. Develop, test, and adopt symptom management assessment tools to identify patients with cancer that may benefit from palliative care referrals for management of symptoms, care support, and/or goals of care conversations (e.g., PCaRES -facilitated assessment of eligibility for palliative care when in the ED) societal drivers of acute care.…”

“…Workshop speakers presented several care delivery strategies that have been tested to minimize unscheduled ED visits and inpatient admissions as well as improve care in these patients. For example, access and care coordination, such as patient navigation [28], webbased symptom self-reporting [29], oncology urgent care clinics, nurse triage [30], and post-discharge interventions [31] have all been shown to reduce ED visits and/or hospitalization. Some ED and urgent care center observation units provide outpatient acute care that lasts more than 24 h in duration but is typically less than 48 h, and these have been reported to reduce inpatient admissions [32].…”

Retrospective study of cancer patients’ predictive factors of care in a large, Hungarian tertiary care centre

“…A large percentage of patients with cancer present to emergency departments (ED) due to a variety of medical conditions ranging from life-threatening conditions such as sepsis and unspecific symptoms such as pain or nausea. 2 …”

“…Cancer is the second-leading cause of mortality in developed countries, and the number of cancer cases and death is projected to increase in the future,1 thus placing a huge strain on the healthcare system. A large percentage of patients with cancer present to emergency departments (ED) due to a variety of medical conditions ranging from life-threatening conditions such as sepsis and unspecific symptoms such as pain or nausea 2…”