Reduction of emergency department utilization via access to outpatient cancer care.

128 Background: Emergency department (ED) utilization for non-emergent medical problems is an inefficient use of medical resources. During calendar year 2013, 224 RIH adult cancer patients presented to the RIH ED. Retrospective review indicated up to 50% of these ED visits were avoidable. Methods: This project was developed for the ASCO Quality Training Program. A multidisciplinary team was assembled to address ED utilization. Retrospective chart review of ED visits included time and reason for visit and primary tumor site. The team selected the Lung Cancer as the target group, developed a cause-and-effect analysis for ED visits, administered a patient survey, and implemented a series of Plan-Do-Study-Act (PDSA) cycles. The team implemented a patient education process of nurse sick-line symptom management and same-day sick visits at RIH CCC as well as developing a single-page patient “sick-line tool” with oncology nurse sick-line contact telephone numbers. A patient navigator introduced the sick-line tool at the first visit and its usage was reinforced at subsequent visits. Results: For RIH CCC lung cancer patients, a standardized symptom-control education process correlated with 30% decrease in ED visits for any presenting complaint (42 visits vs. 60 visits) and 32% decrease in ED visits with presenting complaint of pain (13 visits vs. 19 visits) during January/February 2014 compared to January/February 2013. We did not find significant differences between the proportion of ED visits during Cancer Center business hours, evenings, or weekends. Sick-line calls were found to increase by 53% during January 2014 compared to December 2013 with an additional 35% increase in February 2014. Conclusions: A standardized patient education process resulted in a significant decrease in ED visits, concurrent with an increase in outpatient sick-line utilization. This may reflect an improvement in efficiency of outpatient cancer patient care in a single-institution setting. Given other reports of increased ED utilization by lung cancer patients for similar presenting reasons, these improvements may be generalizable to other institutions.

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Development and Evaluation of Patient Education Materials for Elderly Lung Cancer Patients

Journal of Cancer Education ◽

10.1007/s13187-014-0780-1 ◽

2015 ◽

Vol 31 (1) ◽

pp. 70-74 ◽

Cited By ~ 8

Author(s):

Natalie Jewitt ◽

Andrew J. Hope ◽

Robin Milne ◽

Lisa W. Le ◽

Janet Papadakos ◽

...

Keyword(s):

Lung Cancer ◽

Patient Education ◽

Cancer Patients ◽

Lung Cancer Patients

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P1.01-032 Emergency Department Visits by Lung Cancer Patients in Korea

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2016.11.556 ◽

2017 ◽

Vol 12 (1) ◽

pp. S468

Author(s):

Dong Won Park ◽

Gun Woo Koo ◽

Tai Sun Park ◽

Ji-Yong Moon ◽

Sang-Heon Kim ◽

...

Keyword(s):

Lung Cancer ◽

Emergency Department ◽

Cancer Patients ◽

Emergency Department Visits ◽

Lung Cancer Patients

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Twenty-eight-day mortality in lung cancer patients with metastasis who initiated mechanical ventilation in the emergency department

Scientific Reports ◽

10.1038/s41598-019-39671-8 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Sun Hye Shin ◽

Hyun Lee ◽

Hyung Koo Kang ◽

Joo Hyun Park

Keyword(s):

Lung Cancer ◽

Emergency Department ◽

Mechanical Ventilation ◽

Cancer Patients ◽

Lung Cancer Patients

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Increasing the duration and efficacy of intravenous chemotherapy using a patient-centered digital education program: Navigating Cancer’s program for patients receiving pemetrexed for lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18025 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18025-e18025

Author(s):

Scott C. Howard ◽

Timothy Joseph Yeatman ◽

Mark Layton Watson ◽

Catherine Lam

Keyword(s):

Lung Cancer ◽

Patient Education ◽

Cancer Patients ◽

Education Program ◽

Smoking Status ◽

Multivariable Analysis ◽

Patient Portal ◽

Educational Materials ◽

Specific Patient ◽

Lung Cancer Patients

e18025 Background: Adherence to therapy improves survival in cancer patients. Patient education interventions have effectively improved adherence to oral drugs, but have not been studied for intravenous drugs. Methods: We assessed impact of a pemetrexed educational program for lung cancer patients from 58 oncology practices delivered from 2014-2016 via the Navigating Cancer (www.navigatingcancer.com) patient portal. After online registration, the program provided sequential messages about pemetrexed therapy and management of side effects. Access to each component of the education program was tracked and de-identified data provided to the study team for analysis. Results: Of 944 patients, 441 (47%) accessed pemetrexed-specific educational materials, and were more likely to be Caucasian (p=0.01) and to have never smoked (p=0.05). Patients who accessed educational materials received a mean of 286 days of pemetrexed versus 236 days (p<0.01); their one-year survival was 66% (SE 2.8%) versus 53% (SE 2.9%) (p<0.01). In multivariable analysis, survival was predicted by accessing education (p<0.01), but not race or smoking status (p>0.1). Conclusions: Drug-specific patient education delivered via a patient portal and email reached 47% of registered patients and was associated increased duration of therapy and improved survival. [Table: see text]

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Epidemiologic trends in cancer-related emergency department utilization in Korea from 2015 to 2019

Scientific Reports ◽

10.1038/s41598-021-01571-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sun Young Lee ◽

Young Sun Ro ◽

Sang Do Shin ◽

Sungwoo Moon

Keyword(s):

Emergency Department ◽

Cancer Patients ◽

Incidence Rate ◽

Survival Rates ◽

Incidence Rates ◽

Emergency Department Utilization ◽

Cancer Type ◽

Cross Sectional ◽

Ed Visits ◽

Age And Sex

AbstractIt is inevitable for cancer patients to visit the emergency department (ED) for symptoms of cancer itself and various treatment-related complications. As the prevalence of cancer increases along with cancer survival rates, the number of ED visits of cancer patients may increase. This study aimed to investigate the epidemiologic trends and characteristics of cancer-related ED visits. A cross-sectional study was conducted for all ED visits nationwide between 2015 and 2019. The characteristics of cancer- and non-cancer-related ED visits were compared, and the cancer type and primary reason for ED visits were investigated for cancer-related ED visits. The age- and sex-standardized incidence rate per 100,000 population was calculated. Among 44,983,523 ED visits for 5 years, 1,372,119 (3.1%) were cancer-related. Among cancer-related ED visits, 54.8% led to hospitalization including 5.1% in ICU, and 9.5% died in the hospital. The age- and sex-standardized incidence rates of cancer-related ED visits per 100,000 population increased from 521.8 in 2015 to 642.2 in 2019 (p-for-trends, < 0.01), and rates of cancer-related hospital admission via ED were 309.0 in 2015 and 336.6 in 2019 (p-for-trends, 0.75). The most common cancer types were lung cancer (14.7%), liver cancer (13.1%), and colorectal cancer (11.5%). The most common primary reasons of cancer-related ED visits were pneumonia (3.6%), gastroenteritis (2.7%), fever (2.6%), abdominal pain (2.4%), and ileus (2.1%). Cancer-related ED visits accounted for 3.1% of all ED visits, with 1.37 million cases over five years. The incidence rate of cancer-related ED visits has increased year by year, with high hospitalization and mortality rates, and the burden of cancer-related ED visits will continue to increase as the prevalence increases.

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Resource use in the last three months of life by lung cancer patients in southern Ontario

Current Oncology ◽

10.3747/co.26.4967 ◽

2019 ◽

Vol 26 (4) ◽

Author(s):

Y. Wang ◽

A. Van Dam ◽

M. Slaven ◽

K. J. Ellis ◽

J. R. Goffin ◽

...

Keyword(s):

Lung Cancer ◽

Health Care ◽

End Of Life ◽

Cancer Patients ◽

Acute Care ◽

Resource Use ◽

Small Cell ◽

Small Cell Lung ◽

Lung Cancer Patients ◽

Ed Visits

Background End-of-life cancer care involves multidisciplinary teams working in various settings. Evaluating the quality of care and the feedback from such processes is an important aspect of health care quality improvement. Our retrospective cohort study reviewed health care use by lung cancer patients at end of life, their reasons for visiting the emergency department (ed), and feedback from regional health care professionals.Methods We assessed 162 Ontario patients with small-cell and relapsed or advanced non-small-cell lung cancer. Demographics, disease characteristics, and resource use were collected, and the consenting caregivers for patients with ed visits were interviewed. Study results were disseminated, and feedback about barriers to care was sought.Results Median patient age was 69 years; 73% of the group had non-small-cell lung cancer; and 39% and 69% had received chemotherapy and radiation therapy respectively. Median overall survival was 5.6 months. In the last 3 months of life, 93% of the study patients had visited an oncologist, 67% had telephoned their oncology team, 86% had received homecare, and 73% had visited the ed. Death occurred for 55% of the patients in hospital; 23%, at home; and 22%, in hospice. Goals of care had been documented for 68% of the patients. Homecare for longer than 3 months was associated with fewer ed visits (80.3% vs. 62.1%, p = 0.022). Key themes from stakeholders included the need for more resources and for effective communication between care teams.Conclusions Use of acute-care services and rates of death in an acute-care facility are both high for lung cancer patients approaching end of life. In our study, interprofessional and patient–provider communication, earlier connection to homecare services, and improved access to community care were highlighted as having the potential to lower the need for acute-care resources.

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MP01: The canary in the coal mine: Does palliative care consultation influence emergency department utilization?

CJEM ◽

10.1017/cem.2017.167 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S65

Author(s):

Z. Polsky ◽

E. Lang ◽

A. Sinnarajah ◽

T. Fung ◽

B. Thomas

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Cancer Patients ◽

Administrative Databases ◽

Emergency Department Utilization ◽

Income Support ◽

Gi Cancer ◽

Palliative Care Consultation ◽

Significant Difference ◽

Ed Visits

Introduction: For cancer patients undergoing active treatment, emergency department (ED) visits may be an indicator of a breakdown in continuity and quality of care. Palliative care (PC) may be an important resource for patients in need of symptom management even during treatment with curative intent. This study aims to describe ED utilization by cancer patients and determine if PC consults impact ED use. Methods: Patient data from the Tom Baker Cancer Center (TBCC) was linked to PC and ED data as a retrospective cohort study. ED data was obtained from two administrative databases and PC data was obtained from four administrative databases and restricted to the first four hundred days following diagnosis. Univariate and Multivariate analyses were used. Results: Three actively treated cancer patient cohorts were identified based on first presentation following intake at the TBCC: 1) Used ED first (n=1637), 2) Used PC first (n=539), and 3) Only used services at the TBCC (n=2153). Using Multivariate analysis, patients living alone or who had a diagnosis of prostate or breast cancer were more likely to access the ED first or to only use services at the TBCC rather than access PC first. Patients who were divorced, on income support, or diagnosed with a lung or GI cancer, were more likely to access PC first rather than access the ED or only use services at the TBCC. A subgroup analysis was performed on those who accessed the ED at some point during their care, consisting of three groups: 1) ED Only Users (n=1091), 2) ED First Users, who also accessed PC (n=546), and 3) PC First Users, who also accessed the ED. There was a significant difference in rates of ED visits between the three groups: ED Only Users went to the ED at a rate of 3.8 per 1000 patient days; ED First Users, who also accessed PC, went to the ED at a rate of 7.7 per 1000 patient days; and PC First Users, who also accessed the ED, went to the ED at a rate of 9.2 per 1000 patient days (p< 0.001). Conclusion: In a tertiary cancer centre, patients who were divorced, on income support, or diagnosed with lung or GI cancer were more likely to access PC. Amongst those patients who presented to the ED, those who accessed PC first had higher rates of ED use. Further explorations of presenting complaints, utilization patterns, and symptom burdens will be analyzed to determine if early PC consults can influence or decrease ED utilization.

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