Evaluation of early unplanned readmissions and predisposing factors in an oncology clinic

Güven, Deniz Can; Ceylan, Furkan; Cakir, Ibrahim Yahya; Cesmeci, Engin; Sayınalp, Başak; Yesilyurt, Berkay; Guner, Gurkan; Yıldırım, Hasan Çağrı; Aktepe, Oktay Halit; Arık, Zafer; Türker, Alev; Dizdar, Ömer

doi:10.1007/s00520-020-05927-7

Cited by 4 publications

(4 citation statements)

References 33 publications

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“…The admission rate among real-world patients with mNSCLC receiving chemotherapy was significantly higher than that among RCTs, 51% vs. 16%, highlighting the value of real-world studies given the greater selection of patients in RCTs ( 17 ). We also observed a 30-day readmission rate of 23.3%, showing that many patients would have a high demand for hospital care, consistent with other reports ( 32 , 33 ).…”

Section: Discussionsupporting

confidence: 92%

Patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department

Sánchez,

Nuñez-García,

Ruano-Ravina

et al. 2023

Transl Lung Cancer Res

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Background There is increasing interest in unplanned care utilization among lung cancer patients and its evaluation should allow the identification of areas for quality improvement. Being a major priority for transformation in oncology, we aim to measure the risk and burden of unplanned care in a medical oncology department and identify factors that determine acute care. Methods This was an observational retrospective cohort study that included all lung cancer patients treated at Puerta de Hierro-Majadahonda University Hospital between January 1st 2016 and December 31st 2020. Data cut off: June 30th, 2021. The main objective was to assess the incidence of unplanned care, emergency department (ED) visits and unplanned hospital admissions, from the first visit to the medical oncology service and its potential conditioning variables, considering patient death as a competitive event. As secondary objectives, a description and a quality of unplanned care evaluation was carried out. Results A total of 821 lung cancer patients, all histologies and stages, were included (median follow-up: 32.8 months). Six hundred and eighty-one patients required consultation in the ED (82.9%), and 558 required an unplanned admission (68%). Eighty-six percent of ED consultations and 80.9% of unplanned hospital admissions were related to cancer or its treatment. The 1-year cumulative incidence for ED consultation and for unplanned hospital admission was 71.3% (95% CI: 67.8–74.5%) and 56.7% (95% CI: 53–60%), respectively. In the multivariable analysis, a higher tumor stage increased the risk of consultation in the ED, while a higher stage, Eastern Cooperative Oncology Group performance status (ECOG PS) 2 compared to ECOG PS 0, male sex, opioid or steroid use at first consultation increased the risk of unplanned admission. Conclusions Our study shows that lung cancer patients have an extremely high demand for unplanned care. It is an early need and related to cancer in the majority of consultations and admissions and therefore a key issue for the management of oncology departments. We must optimize the follow-up of patients with a higher risk of unplanned care, advanced lung cancer or symptomatic patients, incorporating remote monitoring strategies and early interventions, as developing specific urgent care pathways for a better comprehensive cancer care.

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Section: Discussionsupporting

confidence: 92%

Patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department

Sánchez,

Nuñez-García,

Ruano-Ravina

et al. 2023

Transl Lung Cancer Res

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“…In the study of Güven et al [16], based on the data of the medical oncology departments, the rate of readmission of cancer patients was reported as 22.7%, and the main determinants as advanced disease stage, polypharmacy, and hospitalization through the emergency department. In our study, all of our patients were readmitted through the emergency service, and 15% of the readmitted patients had advanced non-resectable diseases.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics and management of patients with early readmission to our surgical oncology clinic

Çaparlar

Dokcu

Demirci

2022

The European Research Journal

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Objectives: This study aimed to discuss the frequency of early readmission to the hospital after discharge in our oncology clinic, clinicopathological features, and management of these patients in light of current literature. Methods: The medical records of 237 early readmitted patients within 30 days of discharge in our clinic were retrospectively reviewed. The patients were categorized according to their first diagnosis, Eastern Cooperative Oncology Group (ECOG) performance status, demographic, clinicopathological characteristics, readmission reasons, first treatment type, postoperative complications, the time of application after discharge and the type of treatment after admission.Results: The mean age of the patients was 58.45 years, 57.4% were female, and the mean readmission time after discharge was 11.54 days. The most common primary diagnosis was gastric cancer (35.9%), and the most common emergency pathology requiring hospitalization was ileus-subileus (45.1%). After readmission, 42.6% of the patients received medical treatment. 60% of the readmitted patients had postoperative complications before discharge. Patients who had postoperative complications during the first hospitalization were more likely to have major or minor interventions after readmission (p < 0.01). Admission with a diagnosis of bowel obstruction was associated with the probability of major intervention (p < 0.01). Patients with an ECOG performance score of ≥2 was more frequently administered medical treatment (p = 0.001). Patients admitted with the diagnosis of anastomotic leak/abscess had a higher probability of having postoperative complications (p = 0.001). Conclusions: Readmissions are a concern for all healthcare providers, including comprehensive cancer centers. Recent health policies strive to reduce preventable admissions. Hence, we believe focusing on postoperative complications, and palliative care services is necessary.

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“…Patients hospitalized in the palliative care wards tend to be more fragile, have frequent healthcare contact, and have recurrent hospitalizations, which makes them vulnerable to nosocomial infections. 16,17 International Societies recommend several precautions and infection control measures, and the hospital infection control units implement these recommendations to control nosocomial infections. 12 Hand hygiene is one of the most important nosocomial infection prevention interventions, 18 although the compliance rates are very variable and generally far below the desired rates.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lesson learned from the pandemic: Isolation and hygiene measures for COVID-19 could reduce the nosocomial infection rates in oncology wards

Güven

Eroğlu

Ismayilov

et al. 2021

J Oncol Pharm Pract

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Introduction It was previously demonstrated that seasonal influenza incidence was significantly decreased during the COVID-19 pandemic, possibly due to respiratory and hygiene precautions. From this point, we hypothesized that the COVID-19 precautions could lead to a decrease in nosocomial infection rates in oncology inpatient wards. Methods We evaluated the nosocomial infection rates in an inpatient palliative oncology ward in the first 3 months of the COVID-19 pandemic in our country and compared this rate with the same time frame of the previous year in our institution. Results The percentage of nosocomial infections complicating the hospitalization episodes were significantly reduced in the first 3 months of the pandemic compared to the previous year (43 vs. 55 nosocomial infection episodes; 18.6% vs. 32.2%, p = 0.002). The decrease in the nosocomial infections was consistent in the different types of infections, namely pneumonia (4.8% vs. 7.6%), urinary tract infection (5.2% vs. 7.6%), bacteremia (5.2% vs. 7%) and intraabdominal infections (2.6% vs. 3.5%). The median monthly disinfectant use was significantly increased to 98 liters (interquartile range: 82 – 114) in 2020 compared to 72 L (interquartile range: 36 – 72) in 2019 ( p = 0.046). Conclusion The continuation of the simple and feasible hygiene and distancing measures for healthcare workers and patient relatives and adaptations for earlier discharge could be beneficial for preventing nosocomial infections in oncology wards. These measures could be implemented routinely even after the COVID-19 pandemic for patient safety, especially in settings with higher nosocomial infection rates like inpatients palliative care units.

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Evaluation of early unplanned readmissions and predisposing factors in an oncology clinic

Cited by 4 publications

References 33 publications

Patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department

Patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department

Clinicopathological characteristics and management of patients with early readmission to our surgical oncology clinic

Lesson learned from the pandemic: Isolation and hygiene measures for COVID-19 could reduce the nosocomial infection rates in oncology wards

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