Identification of appropriate and potentially avoidable emergency department referrals in a tertiary cancer care center

Antoun, Sami; Loirat, Philippe; Dipalma, Mario; Minvielle, Étienne

doi:10.1007/s00520-017-3611-1

Cited by 14 publications

(11 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, one endpoint focuses on the reason for emergency referrals. The results obtained in the Emergency Department study [41] have reinforced the value of the intervention programme in terms of reducing the number of unnecessary visits to the emergency department. Inappropriate and avoidable visits appear to be caused by inadequate referral to the most appropriate health professional, which is a key point in the follow-up process.…”

Section: Evaluation Protocolmentioning

confidence: 72%

“…The various studies carried out in support of the CAPRI design process are also summarised in Table 1. Some studies have been published in more detail elsewhere [37][38][39][40][41]. The four exploratory studies (studies 1 to 4) provided a preliminary draft of the CAPRI design including selected components (health technologies and new organisational methods involving nurses specialising in coordination) and the main functions and interaction.…”

Section: Methodological Principles To Support the Rpms Design Processmentioning

confidence: 99%

See 1 more Smart Citation

How to Design a Remote Patient Monitoring System? A French Case Study

Ferrua

Minvielle

Fourcade

et al. 2020

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background: Remote Patient Monitoring Systems (RPMS) based on e-health, Nurse Navigators (NNs) and patient engagement can improve patient follow-up and have a positive impact on quality of care (by limiting adverse events) and costs (by reducing readmissions). However, the extent of this impact depends on effective implementation which is often restricted. This is partly due to the lack of attention paid to the RPMS design phase prior to implementation. The content of the RPMS can be carefully designed at this stage and various obstacles anticipated. Our aim was to report on an RPMS design case to provide insights into the methodology required in order to manage this phase. Methods: This study was carried out at Gustave Roussy, a comprehensive cancer centre, in France. A multidisciplinary team coordinated the CAPRI RPMS design process (2013-2015) that later produced positive outcomes. Data were collected during eight studies conducted according to the Medical Research Council (MRC) framework. This project was approved by the French National Data Protection Authorities. Results: Based on the study results, the multidisciplinary team defined strategies for resolving obstacles prior to the implementation of CAPRI. Consequently, the final CAPRI design includes a web app with two interfaces (patient and health care professionals) and two NNs. The NNs provide regular follow-up via telephone or email to manage patients' symptoms and toxicity, treatment compliance and care packages. Patients contact the NNs via a secure messaging system. Eighty clinical decision support tools enable NNs to prioritise and decide on the course of action to be taken. Conclusion: In our experience, the RPMS design process and, more generally, that of any complex intervention programme, is an important phase that requires a sound methodological basis. This study is also consistent with the notion that an RPMS is more than a technological innovation. This is indeed an organizational innovation, and principles identified during the design phase can help in the effective use of a RPMS (e.g. locating NNs if possible within the care organization; recruiting NNs with clinical and managerial skills; defining algorithms for clinical decision support tools for assessment, but also for patient decision and orientation).

show abstract

Section: Evaluation Protocolmentioning

confidence: 72%

Section: Methodological Principles To Support the Rpms Design Processmentioning

confidence: 99%

How to Design a Remote Patient Monitoring System? A French Case Study

Ferrua

Minvielle

Fourcade

et al. 2020

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…Finally, one endpoint focuses on the reason for emergency referrals. The results obtained in the Emergency Department study (36) have reinforced the value of the intervention programme in terms of reducing the number of unnecessary visits to the emergency department. Inappropriate and avoidable visits appear to be caused by inadequate referral to the most appropriate health professional, which is a key point in the follow-up process.…”

Section: Evaluation Protocolmentioning

confidence: 72%

How to Design a Remote Patient Monitoring System A French Case Study

Ferrua

Minvielle

Fourcade

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background Remote Patient Monitoring Systems (RPMS) based on e-health, Nurse Navigators (NNs) and patient engagement can improve patient follow-up and have a positive impact on quality of care (by limiting adverse events) and costs (by reducing readmissions). However, the extent of this impact depends on effective implementation which is often restricted. This is partly due to the lack of attention paid to the RPMS design phase prior to implementation. The content of the RPMS can be carefully designed at this stage and various obstacles anticipated. Our aim was to report on an RPMS process design to provide an insight into the methodology required in order to manage this phase and the ultimate outcome in terms of RPMS content. Methods This study was carried out at Gustave Roussy, a comprehensive cancer centre in France. A multidisciplinary team comprising hospital managers, healthcare professionals and health service researchers coordinated the CAPRI RPMS design process (2013-2015). It is based on data collected during eight studies conducted in accordance with the principle framework of the UK Medical Research Council (MRC). This project was approved by the French National Data Protection Authorities. Results Based on the study results, the multidisciplinary team defined strategies for resolving obstacles and risks prior to the implementation of CAPRI. Consequently, the final CAPRI design includes a web app with two interfaces (patient and health care professionals) and two NNs. The NNs provide regular follow-up via telephone and/or email to manage patients' symptoms and toxicity, treatment compliance and care packages. Patients contact the NNs via a secure messaging system. Eighty graduation and orientation algorithms enable NNs to prioritise and decide on the course of action to be taken. Conclusion In our experience, the RPMS design process and, more generally, that of any complex intervention programme, is an important phase that requires a sound methodological basis. This study also suggests that an RPMS is more than a technological innovation. Indeed, it is an organisational innovation, the merits of which will depend on the precise definition given to the action taken by NNs and other healthcare professionals as well as patients throughout their interactions.

show abstract

“…Involving the GP in all the stages leading up to treatment optimizes follow-up and care coordination [38,39]. Furthermore, the implication of the general practitioner in the health care decreases the number of visits to the emergency department [39,40]. Our ndings suggest that oncologists should inform the patient about the role of their GP.…”

Section: Comparison With Existing Literaturementioning

confidence: 87%

“…In practice, this stage is often neglected; the literature nds that the GP is delegated to disclose the diagnosis to the patient in 19% of cases and that it is the patient who discloses their own diagnosis to the GP in 18% of cases [9]. Involving the GP in all the stages leading up to treatment optimizes follow-up and care coordination [38,39]. Furthermore, the implication of the general practitioner in the health care decreases the number of visits to the emergency department [39,40].…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Improving communication between the general practitioner and the oncologist: a key role in coordinating care for patients suffering from cancer.

Druel

Gimenez

Paricaud³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Patients suffering from cancers are increasingly numerous in general practice consultations. The General Practitioner (GP) should be at the heart of the management of patients. Several studies have examined the perceptions of GPs confronted with the patient suffering from cancer and the relationships of GPs with oncologists, but few studies have focused on the patients’ perspective. We studied the three-way relationship between the oncologist, the GP, and the patient, from the patient’s point of view. Methods: A questionnaire validated by a group consisting of GPs, oncologists, nurses, an epidemiologist and quality analyst, was administered over a three-week period to patients suffering from cancer receiving chemotherapy in a day hospital. Results: The analysis was based on 403 questionnaires. Patients had confidence in the GP’s knowledge of oncology in 88 % of cases; 49 % consulted their GP for pain, 15 % for cancer-related advice, and 44 % in emergencies. Perceived good GP/oncologist communication led patients to turn increasingly to their GP for cancer-related consultations (RR = 1.14; p = 0.01) and gave patients confidence in the GP’s ability to manage cancer-related problems (RR = 1.30; p < 0.01). Mention by the oncologist of the GP’s role increased the consultations for complications (RR = 1.82; p < 0.01) as well as recourse to the GP in an emergency (RR = 1.35; p < 0.01). Conclusion: Patients suffering from cancer considered that the GP was competent, but did not often consult their GP for cancer-related problems. There is a discrepancy between patients’ beliefs and their behaviour. When the oncologist spoke to patients of the GP’s role, patients had recourse to their GP more often. Systematically integrating a GP consultation to conclude cancer diagnosis disclosure, could improve management and care coordination.

show abstract

Identification of appropriate and potentially avoidable emergency department referrals in a tertiary cancer care center

Abstract: Potentially avoidable ED referrals are common in patients with cancer. These potentially avoidable ED referrals underline the importance of several domains of care coordination.

Cited by 14 publications

References 32 publications

How to Design a Remote Patient Monitoring System? A French Case Study

How to Design a Remote Patient Monitoring System? A French Case Study

How to Design a Remote Patient Monitoring System A French Case Study

Improving communication between the general practitioner and the oncologist: a key role in coordinating care for patients suffering from cancer.

Contact Info

Product

Resources

About