Retrospective study of unplanned hospital admission for metastatic cancer patients visiting the emergency department

2016 ◽  
Vol 25 (5) ◽  
pp. 1409-1415 ◽  
Author(s):  
Tae Tanaka ◽  
Masataka Taguri ◽  
Soichi Fumita ◽  
Kunio Okamoto ◽  
Yoshio Matsuo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Hospital Admission ◽  
Cancer Patients ◽  
Metastatic Cancer

Impact of cancer on emergency department outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18618-e18618
Author(s):  
Alexander S. Qian ◽  
Edmund M. Qiao ◽  
Vinit Nalawade ◽  
Rohith S. Voora ◽  
Nikhil V. Kotha ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Cancer Patients ◽  
Metastatic Cancer ◽  
Inpatient Admission ◽  
Cancer Site ◽  
Patients With Cancer ◽  
Increased Risk

e18618 Background: Cancer patients frequently utilize the Emergency Department (ED) for a variety of diagnoses, both related and unrelated to their cancer. Patients with cancer have unique risks related to their cancer and treatment which could influence ED-related outcomes. A better understanding of these risks could help improve risk-stratification for these patients and help inform future interventions. This study sought to define the increased risks cancer patients face for inpatient admission and hospital mortality among cancer patients presenting to the ED. Methods: From the National Emergency Department Sample (NEDS) we identified patients with and without a diagnosis of cancer presenting to the ED between 2016 and 2018. We used International Classification of Diseases, version 10 (ICD10-CM) codes to identify patients with cancer, and to identify patient’s presenting diagnosis. Multivariable mixed-effects logistic regression models assessed the influence of cancer diagnoses on two endpoints: hospital admission from the ED, and inpatient hospital mortality. Results: There were 340 million weighted ED visits, of which 8.3 million (2.3%) occurred in patients with a cancer diagnosis. Compared to non-cancer patients, patients with cancer had an increased risk of inpatient admission (64.7% vs. 14.8%; p < 0.0001) and hospital mortality (4.6% vs. 0.5%; p < 0.0001). Factors associated with both an increased risk of hospitalization and death included older age, male gender, lower income level, discharge quarter, and receipt of care in a teaching hospital. We identified the top 15 most common presenting diagnoses among cancer patients, and among each of these diagnoses, cancer patients had increased risks of hospitalization (odds ratio [OR] range 2.0-13.2; all p < 0.05) and death (OR range 2.1-14.4; all p < 0.05) compared to non-cancer patients with the same diagnosis. Within the cancer patient cohort, cancer site was the most robust individual predictor associated with risk of hospitalization or death, with highest risk among patients with metastatic cancer, liver and lung cancers compared to the reference group of prostate cancer patients. Conclusions: Cancer patients presenting to the ED have high risks for hospital admission and death when compared to patients without cancer. Cancer patients represent a distinct population and may benefit from cancer-specific risk stratification or focused interventions tailored to improve outcomes in the ED setting.

Primary diagnoses and outcomes of emergency department visits in older people with dementia: a hospital-based retrospective study in Taiwan

2019 ◽  
Vol 32 (1) ◽  
pp. 97-104
Author(s):  
Pei-Chao Lin ◽  
Li-Chan Lin ◽  
Hsiu-Fen Hsieh ◽  
Yao-Mei Chen ◽  
Pi-Ling Chou ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Retrospective Study ◽  
Older People ◽  
Hospital Admission ◽  
Emergency Department Visits ◽  
Urban Setting ◽  
Research Database ◽  
Patient Records ◽  
People With Dementia

ABSTRACTObjectives:The objectives of this study were to investigate the primary diagnoses and outcomes of emergency department visits in older people with dementia and to compare these parameters with those in older adults without dementia.Design and Setting:This hospital-based retrospective study retrieved patient records from a hospital research database, which included the outpatient and inpatient claims of two hospitals.Participants:The patient records were retrieved from the two hospitals in an urban setting. The inclusion criteria were all patients aged 65 and older who had attended the two hospitals as an outpatient or inpatient between January 1, 2009, and December 31, 2016. Patients with dementia were identified to have at least three reports of diagnostic codes, either during outpatient visits, during emergency department visits, or in hospitalized database records. The other patients were categorized as patients without dementia.Measurements:The primary diagnosis during the emergency department visit, cost of emergency department treatment, cost of hospital admission, length of hospital stay, and diagnosis of death were collected.Results:A total of 149,203 outpatients and inpatients aged 65 and older who were admitted to the two hospitals were retrieved. The rate of emergency department visits in patients with dementia (23.2%) was lower than that in those without dementia (48.6%). The most frequent primary reason for emergency department visits and the main cause of patient death was pneumonia. Patients with dementia in the emergency department had higher hospital admission rates and longer hospital stays; however, the cost of treatment did not show a significant difference between the two groups.Conclusions:Future large and prospective studies should explore the severity of disease in older people with dementia and compare results with older adults without dementia in the emergency department.

Derivation and validation of a risk model for emergency department palliative care needs assessment using the Screen for Palliative and End-of-Life Care Needs in the Emergency Department (SPEED).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 22-22
Author(s):  
Danielle Moulia ◽  
Zachary O. Binney ◽  
Tammie E. Quest ◽  
Paul DeSandre ◽  
Sharon Vanairsdale ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Cancer Patients ◽  
Risk Model ◽  
Metastatic Cancer ◽  
Hospital Death ◽  
Care Needs ◽  
Temporal Validation ◽  
Speed Score ◽  
Palliative Care Needs

22 Background: A key setting for the provision of palliative care is the emergency department (ED) where important decisions regarding treatment and next site of care are determined; however identifying patients who would benefit from a palliative care consult is an ongoing challenge. The (SPEED) is a 5-question tool that assesses unmet palliative care needs. Methods: We performed a retrospective derivation and temporal validation of a risk model for a palliative care event (PCE) among cancer patients with an ED visit and subsequent hospital admission using data available upon arrival, including data from the SPEED tool. A PCE was defined as a palliative care consult, discharge to hospice, or in-hospital death. We developed a multivariate logistic regression model to predict PCEs. We assessed model performance using a receiver operating characteristic curve and visual inspection of quintile plots. Results: Eleven factors were identified as predictive of a PCE, including SPEED score, proxy SPEED informer, age, EMS arrival, emergent or immediate ED acuity, the number of ED visits within the last 90 days, metastatic cancer, cardiac arrhythmias, coagulopathy, depression and weight loss. In validation, the risk model had an area under the curve of 0.72 and calibration showed an underestimation of risk in the second and third quintiles. Conclusions: A risk model based on SPEED score has been successfully derived, but needs a larger dataset for proper validation. If the predictive ability of the model is confirmed, a risk model can efficiently identify cancer patients arriving to the ED who may benefit from early initiation of a palliative care consult.

The retrospective study for unplanned hospital admission of patients with cancer who visited the emergency department.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e20703-e20703
Author(s):  
Tae Tanaka ◽  
Hidetoshi Hayashi ◽  
Masataka Taguri ◽  
Soichi Fumita ◽  
Yoshio Matsuo
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Hospital Admission ◽  
Patients With Cancer

scholarly journals The Retrospective Study for Unplanned Hospital Admission of Patients with Cancer Who Visited the Emergency Department

2014 ◽  
Vol 25 ◽  
pp. v52
Author(s):  
Tae Tanaka ◽  
Hidetoshi Hayashi ◽  
Masataka Taguri ◽  
Soichi Fumita ◽  
Yoshio Matsuo
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Hospital Admission ◽  
Patients With Cancer

scholarly journals MP37: Emergency department boarding of admitted oncology patients receiving chemotherapy

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S55-S56
Author(s):  
K. Grewal ◽  
S. McLeod ◽  
R. Sutradhar ◽  
M. Krzyzanowska ◽  
B. Borgundvaag ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Cancer Patients ◽  
Hospital Length ◽  
Primary Objective ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Administrative Databases ◽  
Ed Crowding

Introduction: Emergency department (ED) boarding is associated with worse outcomes for critically ill patients. There have been mixed findings in other patient populations. The primary objective of this study was to examine predictors of prolonged ED boarding among cancer patients receiving chemotherapy who required hospital admission from the ED. Secondary objectives were to examine the association between prolonged ED boarding and in-hospital mortality, 30-day mortality, and hospital length of stay (LOS). Methods: Using administrative databases from Ontario, we identified adult (≥ 18 years) cancer patients who received chemotherapy within 30 days prior to a hospital admission from the ED between 2013 to 2017. ED boarding time was calculated as the time from the decision to admit the patient to when the patient physically left the ED. Prolonged ED boarding was defined as ≥ 8 hours. Multivariable logistic regression was used to examine predictors of prolonged ED boarding and to determine if prolonged boarding was associated with mortality. Multivariable quantile regression was used to determine the association between prolonged boarding and hospital LOS. Results: 45,879 patients were included in the study. Median (interquartile range (IQR)) ED LOS of stay was 11.8 (7.0, 21.7) hours and median (IQR) ED boarding time was 4.2 (1.6, 14.2) hours. 17,053 (37.2%) patients had prolonged ED boarding. Severe ED crowding was the strongest predictor of prolonged ED boarding (odds ratio: 17.7, 95% CI: 15.0 to 20.9). Prolonged ED boarding was not associated with in-hospital mortality or 30-day mortality. Median hospital LOS was over 9 hours (p <0.0001) longer among patients with the longest ED boarding times. Conclusion: Severe ED crowding was associated with a significant increase in the odds of prolonged ED boarding. While our study demonstrated that prolonged boarding was not associated with increased mortality, further work is required to understand if ED boarding is associated with other adverse outcomes in this immunocompromised population.

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