scholarly journals Treat-and-Release Emergency Department Utilization by Patients With Gynecologic Cancers

2019 ◽  
Vol 15 (5) ◽  
pp. e428-e438
Author(s):  
Benjamin B. Albright ◽  
Mucio K. Delgado ◽  
Nawar A. Latif ◽  
Robert L. Giuntoli ◽  
Emily M. Ko ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Emergency Department ◽  
Low Socioeconomic Status ◽  
Wound Care ◽  
Gynecologic Cancer ◽  
Urgent Care ◽  
Emergency Department Utilization ◽  
Gynecologic Cancers ◽  
Therapeutic Procedures ◽  
Ed Visits

PURPOSE: Seventeen percent of patients with cancer visit the emergency department (ED) annually, often with nonemergent complaints. We sought to describe the burden of treat-and-release ED utilization by patients with gynecologic cancers and to identify opportunities for improved triage. MATERIALS AND METHODS: Patients with gynecologic cancer diagnoses who were treated and released were identified within the Nationwide Emergency Department Sample, a stratified sample of US hospital-based ED visits, from 2009 to 2013. Sample weights were applied to generate national estimates. Associations with visit charges were assessed with weighted multivariable linear regression. RESULTS: Between 2009 and 2013, there were an estimated 174,092 annual treat-and-release ED visits by patients with gynecologic cancer (95% CI, 163,480 to 184,703 visits), which corresponded to $736 million in annual charges with an average visit charge of $4,232 (95% CI, $4,099 to $4,366). Annual visits and total charges increased significantly over the 5 years under study. Visits were more frequent for patients with cervical cancer (44.1%) versus ovarian (27.8%) and uterine (24.6%) cancer. These patients were younger and more likely to be from low socioeconomic status areas. The most common primary diagnoses were similar across cancers, including abdominal pain (10.5%), chest pain (6.1%), and urinary tract infection (5.2%). The most frequent diagnostics were culture/smear, computed tomography scan, and x-ray, and the most frequent therapeutic procedures included wound care, transfusion, and paracentesis. CONCLUSION: Patients with gynecologic cancers, and cervical cancer in particular, are frequently seen in the ED with issues that could be less expensively managed in an outpatient clinic or urgent care setting. Visit frequency, but not per-visit cost, is increasing over time.

Emergency department utilization by patients with gynecologic cancer in the United States

2020 ◽  
pp. ijgc-2020-001520
Author(s):  
Benjamin B Albright ◽  
Mucio K Delgado ◽  
Nawar A Latif ◽  
Robert L Giuntoli ◽  
Emily M Ko ◽  
...  
Keyword(s):  
United States ◽  
Cervical Cancer ◽  
Emergency Department ◽  
Gynecologic Cancer ◽  
The United States ◽  
Emergency Department Visits ◽  
Emergency Department Utilization ◽  
Gynecologic Cancers ◽  
Emergency Department Care ◽  
Co Morbidity

IntroductionPayment reform will give oncologists increasing responsibility for how patients with cancer meet unexpected care needs.ObjectiveTo differentiate how patients with gynecologic cancers use emergency care, and to assess the characteristics associated with potentially avoidable treat-and-release visits.MethodsWe performed a retrospective cohort study using the Nationwide Emergency Department Sample, a stratified sample of visits in United States hospital-based emergency departments, from 2010 to 2014. Visits by patients with a diagnosis of gynecologic cancer were selected. Sample weights were applied to calculate national estimates of care patterns and trends. Associations with treat-and-release disposition were assessed with weighted logistic regression.ResultsIn the study period, patients with gynecologic cancer made an estimated 370 104 annual emergency department visits (95% CI 351 997 to 388 211). A total of 50.2% of patients were treated and released, 48% were admitted, 1.6% were transferred, and 0.1% died. These visits corresponded to over US$1.27 billion in annual charges, with an average charge of US$3428 per visit (95% CI 3348 to 3509). Driven by growing treat-and-release utilization, annual visits increased, while admission rates fell over time. Patients with cervical cancer represented the plurality (36%) of visits; they were relatively younger, of lower socioeconomic status, and had fewer co-morbidities. Models for treat-and-release disposition did not vary significantly across different cancer populations. In the all-cancer model, increased odds of treat-and-release disposition was associated with cervical cancer diagnosis, younger age, lesser Elixhauser co-morbidity, Medicare coverage (OR=1.19; p<0.001), Medicaid coverage (OR=1.25; p<0.001), uninsured status (OR=1.70; p<0.001), and weekend visits. Visits in the northeast, at urban hospitals, and in winter months showed decreased odds of treat-and-release disposition.DiscussionPatients with gynecologic cancers have been using the emergency department at increasing rates, primarily driven by treat-and-release visits that did not result in admission or death. Patients with cervical cancer have higher rates of treat-and-release utilization and may over-use emergency department care.

scholarly journals First and Second Wave Dynamics of Emergency Department Utilization during the COVID-19 Pandemic: a retrospective study

2021 ◽  
Author(s):  
Robi Dijk ◽  
Patricia Plaum ◽  
Stan Tummers ◽  
Frits van Osch ◽  
Dennis Barten ◽  
...  
Keyword(s):  
Emergency Department ◽  
Urgent Care ◽  
Emergency Department Utilization ◽  
Reference Period ◽  
Wave Dynamics ◽  
Admission Rates ◽  
High Urgency ◽  
Ed Visits ◽  
Second Wave ◽  
Insight Into

Background: Since the COVID-19 pandemic, there has been a decrease in emergency department(ED) utilization. Although this has been thoroughly characterized for the first wave(FW), studies during the second wave(SW) are limited. We examined the changes in ED utilization between the FW and SW, compared to 2019 reference periods. Methods: We performed a retrospective analysis of ED utilization in 3 Dutch hospitals in 2020. The FW and SW (March until June and September until December, respectively) were compared to the reference periods in 2019. ED visits were labeled as (non)COVID suspected. Findings: During the FW and SW ED visits decreased by 20.3% and 15.3%, respectively, when compared to reference periods in 2019. During both waves high urgency visits significantly increased with 3.1% and 2.1%, and admission rates (ARs) increased with 5.0% and 10.4%. Trauma related visits decreased by 5.2% and 3.4%. During the SW we observed less COVID-related visits compared to the FW (4,407 vs 3,102 patients). COVID related visits were significantly more often in higher need of urgent care and ARs where at least 24.0% higher compared to non COVID visits. Interpretation: During both COVID-19 waves ED visits were significantly reduced, with the most distinct decline during the FW. ED patients were more often triaged as high urgent and the ARs were increased compared to the reference period in 2019, reflecting a high burden on ED resources. These findings indicate the need to gain more insight into motives of patients to delay or avoid emergency care during pandemics and prepare EDs for future pandemics.

Assessment of a multi-center tele-urgent care program to decrease emergency department referral rates in the Veterans Health Administration

2021 ◽  
pp. 1357633X2110248
Author(s):  
Charlie M Wray ◽  
Myla Junge ◽  
Salomeh Keyhani ◽  
Janeen E Smith
Keyword(s):  
Emergency Department ◽  
Emergency Department Visit ◽  
Care Program ◽  
Urgent Care ◽  
Emergency Department Utilization ◽  
Emergency Department Care ◽  
Referral Rates ◽  
Care Assessment ◽  
The Impact ◽  
Care Evaluation

The use of emergency departments for non-emergent issues has led to overcrowding and decreased the quality of care. Telemedicine may be a mechanism to decrease overutilization of this expensive resource. From April to September 2020, we assessed (a) the impact of a multi-center tele-urgent care program on emergency department referral rates and (b) the proportion of individuals who had a subsequent emergency department visit within 72 h of tele-urgent care evaluation when they were not referred to the emergency department. We then performed a chart review to assess whether patients presented to the emergency department for the same reason as was stated for their tele-urgent care evaluation, whether subsequent hospitalization was needed during that emergency department visit, and whether death occurred. Among the 2510 patients who would have been referred to in-person emergency department care, but instead received tele-urgent care assessment, one in five (21%; n = 533) were subsequently referred to the emergency department. Among those not referred following tele-urgent care, 1 in 10 (11%; n = 162) visited the emergency department within 72 h. Among these 162 individuals, most (91%) returned with the same or similar complaint as what was assessed during their tele-urgent care visit, with one in five requiring hospitalization (19%, n = 31) with one individual (0.01%) dying. In conclusion, tele-urgent care may safely decrease emergency department utilization.

Effects of Hurricanes on Emergency Department Utilization: An Analysis Across 7 US Storms

2020 ◽  
pp. 1-8
Author(s):  
Kevin C Heslin ◽  
Marguerite L Barrett ◽  
Molly Hensche ◽  
Gary Pickens ◽  
Jeanne S Ringel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Preparedness ◽  
Emergency Department Utilization ◽  
Disease Category ◽  
Preparedness Planning ◽  
Emergency Managers ◽  
Planning Processes ◽  
Ed Visits ◽  
The Impact ◽  
Population Rate

ABSTRACT Objective: Emergency departments (EDs) are critical sources of care after natural disasters such as hurricanes. Understanding the impact on ED utilization by subpopulation and proximity to the hurricane’s path can inform emergency preparedness planning. This study examines changes in ED utilization for residents of 344 counties after the occurrence of 7 US hurricanes between 2005 and 2016. Methods: This retrospective observational study used ED data from the Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases. ED utilization rates for weeks during and after hurricanes were compared with pre-hurricane rates, stratified by the proximity of the patient county to the hurricane path, age, and disease category. Results: The overall population rate of weekly ED visits changed little post-hurricane, but rates by disease categories and age demonstrated varying results. Utilization rates for respiratory disorders exhibited the largest post-hurricane increase, particularly 2–3 weeks following the hurricane. The change in population rates by disease categories and age tended to be larger for people residing in counties closer to the hurricane path. Conclusions: Changes in ED utilization following hurricanes depend on disease categories, age, and proximity to the hurricane path. Emergency managers could incorporate these factors into their planning processes.

Why are people increasingly attending the emergency department? A study of the French healthcare system

2019 ◽  
Vol 36 (9) ◽  
pp. 548-553 ◽  
Author(s):  
Helene Colineaux ◽  
Fanny Pelissier ◽  
Laure Pourcel ◽  
Thierry Lang ◽  
Michelle Kelly-Irving ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Regression Models ◽  
Age Groups ◽  
Average Increase ◽  
Linear Regression Models ◽  
Clinical Classification ◽  
Therapeutic Procedures ◽  
Ed Visits

ObjectiveIt is often asserted that the crowding phenomenon in emergency departments (ED) can be explained by an increase in visits considered as non-urgent. The aim of our study was to quantify the increase in ED visit rates and to determine whether this increase was explained by non-severe visit types.MethodsThis observational study covers all ED visits between 2002 and 2015 by adult inhabitants of the Midi-Pyrénées region in France. Their characteristics were collected from the emergency visit summaries. We modelled the visit rates per year using linear regression models, and an increase was considered significant when the 95% CIs did not include zero. The severity of the patients’ condition during ED visit was determined through the ‘Clinical Classification of Emergency’ score. Non-severe visits were those where the patient was stable, and the physician deemed no intervention necessary. Intermediate-severity visits concerned patients who were stable but requiring diagnostic or therapeutic procedures.ResultsThe 37 studied EDs managed >7 million visits between 2002 and 2015. There was an average increase of +4.83 (95% CI 4.33 to 5.32) visits per 1000 inhabitants each year. The increase in non-severe visit types was +0.88 (95% CI 0.42 to 1.34) per 1000 inhabitants, while the increase in intermediate-severity visit types was +3.26 (95% CI 2.62 to 3.91) per 1000 inhabitants. This increase affected all age groups and all sexes.DiscussionIt appears that the increase in ED use is not based on an increase in non-severe visit types, with a greater impact of intermediate-severity visit types requiring diagnostic or therapeutic procedures in ED.

scholarly journals P035: Impact of EMS direct referral to community care on emergency department utilization

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S75
Author(s):  
A. Dukelow ◽  
M. Lewell ◽  
J. Loosley ◽  
S. Pancino ◽  
K. Van Aarsen
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Community Care ◽  
Home Care Services ◽  
Emergency Department Visits ◽  
Emergency Department Utilization ◽  
Care Services ◽  
Significant Difference ◽  
Ed Visits ◽  
The Impact

Introduction: The Community Referral by Emergency Medical Services (CREMS) program was implemented in January 2015 in Southwestern Ontario. The program allows Paramedics interacting with a patient to directly refer those in need of home care support to their local Community Care Access Centre (CCAC) for needs assessment. If indicated, subsequent referrals are made to specific services (e.g. nursing, physiotherapy and geriatrics) by CCAC. Ideally, CREMS connects patients with appropriate, timely care, supporting individual needs. Previous literature has indicated CREMS results in an increase of home care services provided to patients. Methods: The primary objective of this project is to evaluate the impact of the CREMS program on Emergency Department utilization. Data for all CCAC referrals from London-Middlesex EMS was collected for a thirteen month period (February 2015-February 2016). For all patients receiving a new or increased service from CCAC the number of Emergency Department visits 2 years before referral and 2 years after referral were calculated. A related samples Wilcoxon Signed Rank Test was performed to examine the difference in ED visits pre and post referral to CCAC. Results: There were 213 individuals who received a new or increased service during the study timeframe. Median [IQR] patient age was 77 [70-85.5]. 113/213 (53%) of patients were female. The majority of patients 135/213 (63.4%) were a new referral to CCAC. The median [IQR] number of hospital visits before referral was 3 [1-5] and after referral was 2 [0-4]. There was no significant difference in the overall number of ED visits before versus after referral (955 vs 756 visits, p = 0.051). Conclusion: Community based care can improve patient experience and health outcomes. Paramedics are in a unique position to assess patients in their home to determine who might benefit from home care services. CREMS referrals for this patient group showed a trend towards decreased ED visits after referral but the trend was not statistically significant.

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

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 128-128 ◽  
Author(s):  
Kenneth D. Bishop ◽  
Mary Anne Fenton ◽  
Tara Szymanski ◽  
Megan Begnoche
Keyword(s):  
Lung Cancer ◽  
Emergency Department ◽  
Patient Education ◽  
Cancer Patients ◽  
Emergency Department Utilization ◽  
Primary Tumor Site ◽  
Lung Cancer Patients ◽  
Oncology Nurse ◽  
Ed Visits ◽  
Education Process

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.

Understanding what drives patients with cancer to visit the emergency department: A qualitative study.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 173-173
Author(s):  
Avery Longmore ◽  
Nicole Veloce ◽  
Marck Mercado ◽  
Katie Dainty ◽  
Lisa K. Hicks
Keyword(s):  
Emergency Department ◽  
Low Socioeconomic Status ◽  
Comparison Method ◽  
Medical Advice ◽  
Coordination Of Care ◽  
Low Socioeconomic ◽  
Patients With Cancer ◽  
Broad Agreement ◽  
Ed Visits ◽  
Community Supports

173 Background: Visits to the emergency department (ED) are common among patients with cancer (PWCs). Previous research suggests that few ED visits are precipitated by true oncologic emergencies (Diaz-Couselo 2004). Designing initiatives to reduce ED visits requires a rich understanding of factors that drive PWCs to visit the ED. Methods: Standardized interviews were conducted with 12 oncology clinicians at an academic oncology clinic in Toronto, Canada. Interviews were also conducted with 10 PWCs. Interviews explored factors that may drive ED visits, and interviewees’ insights into interventions to prevent ED visits. Interviews were audio recorded and transcribed. Transcriptions were qualitatively analyzed by two independent reviewers using the constant comparison method (Strauss and Corbin 1998). Results: Ten themes were identified as factors that may drive ED visits, with little overlap between themes identified by clinicians versus those identified by PWCs. Clinicians identified low socioeconomic status, lack of social support, advanced age, comorbidities, anxiety and non-adherence as important factors. In contrast, PWCs focused on the severity and expectedness of symptoms, lack of access to afterhours oncology advice and care, and adherence with medical and non-medical advice as drivers of ED visits. Regarding potential interventions, there was broad agreement between clinicians and PWCs regarding what might be helpful. Both groups identified improved access to expert cancer advice/care, improved coordination of care between clinics and ancillary health services, and patient education as important interventions. Clinicians also believed increasing community supports would help prevent ED visits. PWCs emphasized that some ED visits are not preventable. Conclusions: Clinicians and PWCs have different views on what drives ED visits. Despite identifying different drivers, clinicians and PWCs identified common solutions for reducing ED visits.

Relationship of emergency department use pre- and post-cancer diagnosis in safety-net adults.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6626-6626
Author(s):  
Arthur Hong ◽  
Navid Sadeghi ◽  
John Vernon Cox ◽  
Simon Craddock Lee ◽  
Ethan Halm
Keyword(s):  
Emergency Department ◽  
Cancer Diagnosis ◽  
Initial Treatment ◽  
Safety Net ◽  
Urgent Care ◽  
Cancer Type ◽  
Advanced Stage ◽  
Seeking Behavior ◽  
Ed Visits ◽  
Advanced Stage Cancer

6626 Background: Safety-net adults generate a high rate of emergency department (ED) visits within the 180 days after a new cancer diagnosis, many of which could be alternatively triaged to an urgent care clinic. It is unclear how much of this ED use is attributable to the cancer and treatment vs. ED-seeking behavior. To identify patients at risk of frequent ED use, we explored whether a patient’s pre-cancer ED visit use predicted ED use after diagnosis. Methods: We identifiably linked adults from the tumor registry in the Dallas County safety-net health system to a regional hospital database with claims-like data for all patients from 98% of non-federal hospitals in North Texas. We applied a mixed-effects multivariate logit model, using frequent ED use (≥4 visits) in the 6-12 months or 12-18 months before diagnosis to predict frequent ED use after diagnosis, adjusting for demographics, comorbidities; cancer type, stage, initial treatment modalities; and grouping visits at the patient level. Results: Of 8,610 adults diagnosed from 2012-2016, 76.2% had Medicaid or were uninsured, 30.9% had lung, breast, or colorectal cancer, and 25.9% had advanced-stage cancer at diagnosis. In the 180 days after diagnosis, 42.5% of patients had zero ED visits, 45.7% had 1-3 visits, and 11.8% were frequent ED users (≥4). In multivariate analysis, patients with frequent ED use in the 6-12 months before a cancer diagnosis had 6.7 higher odds (95% CI: 4.8, 9.3) of having frequent ED use after diagnosis, compared to patients who had zero ED visits prior to diagnosis. This compared to 1.3 higher odds (95% CI: 1.1, 1.5) of frequent ED use if the patient had advanced-stage cancer, and 2.1 higher odds (95% CI: 1.8, 2.4) if chemotherapy was part of initial treatment. Although most post-diagnosis frequent ED users generated zero visits (62.2%) or 1-3 visits (30.7%) in the 6-12 months prior to diagnosis, 38% of patients with frequent ED use pre-diagnosis continued frequent ED visits after diagnosis. Results were similar for ED use 12-18 months prior to diagnosis. Conclusions: Among safety-net adults, prior ED-seeking behavior strongly predicted ED use after a new cancer diagnosis. This may represent a high-risk group that might benefit from care delivery innovation.

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