Emergency Department Visits made by Patients with Cancer; Analysis of Data from a Single Community Cancer Center

Purpose: Cancer-related Emergency Department Visits (EDV) are costly and may indicate poor care. Most studies of cancer-related EDV identify patients using inclusive diagnostic codes but lack precision since they don’t distinguish active cancer. We compared estimates of oncology-related EDV made by diagnostic code methods to a more specific method followed by chart review. We also studied characteristics of validated EDV. Methods: EDV from cancer patients at a single acute care hospital were measured using any inclusive oncology codes and was compared to EDV made by patients who were active attendees at cancer clinics. We then reviewed the records of a 50% random sample of the ‘active’ patients to estimate how many were related to cancer or cancer treatment. Results: Over 5 months, 790 oncology-EDV were identified by coding, but only 554 (70%) were made by ‘active’ patients. After review, 29% of active patient EDV was determined not to be related to an oncology problem or treatment. 48% of EDV occurred during daytime clinic hours. 79% were preceded by one or more contacts with the oncology care team within a week. There was variability in the number of EDV by patients of different oncologists. Conclusion: The impact of cancer in overall EDV counts is over-estimated by coding because coding cannot distinguish between active and inactive cancer nor discriminate between symptoms likely due to unlikely due to cancer or cancer treatments. Cancer programs should study the experiences of their own patients to design effective programs to reduce potentially avoidable utilization.

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A Sample of The Relationship Between The Non-Integrated Healthcare System And National Epidemic of Emergency Department Overcrowding In Turkey

10.21203/rs.3.rs-818815/v1 ◽

2021 ◽

Author(s):

Cihad Dundar ◽

Seydanur Dal Yaylaoglu

Keyword(s):

Emergency Department ◽

Female Gender ◽

Tertiary Hospital ◽

Emergency Department Visits ◽

Work Hours ◽

Diagnostic Code ◽

Diagnostic Codes ◽

Logistic Analysis ◽

Ed Visits ◽

Negative Impacts

Abstract Background: The use of EDs has significantly increased, and a majority of this increase is attributed to non-urgent visits, which has negative impacts. We aim to explore the frequency of non-urgent emergency department (ED) visits and to identify risk factors for non-urgent ED visits. Methods: This retrospective, the record-based study was conducted at a tertiary hospital in Samsun province of Turkey. The records of all adult patients who visited to the ED between January 1 and December 31, 2017, were included in this study. All emergency department visits were evaluated according to age, gender, time of visit, means of arrival, ICD diagnostic codes, and the number of repeated non-urgent ED visits. The number of ED visits was 87,528 for the year 2017. Results: The non-urgent emergency visit rate was 9.9%. According to binary logistic analysis, non-urgent visits were associated with young age (OR = 2.75), female gender (OR = 1.11) and non-ambulance transportation (OR = 9.86). The prevalence of non-emergent visits was very similar between weekends and weekdays but was significantly higher in work hours on weekdays than non-work hours (p<0.001). The most frequent diagnostic code was “Pain, unspecified” (R52) and the rate of repeated visits was 14.8% of non-urgent ED visits. Conclusions: Harmonization of various databases at the primary level in terms of design and connectivity and integration with hospital information systems will contribute to the identification of problems and the generation of solutions. The next step is establishing an integrated health care system that can benefit emergency care organizations in Turkey.

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Self report assessment and support for cancer symptoms: Impact on hospital admissions and emergency department visits.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20552 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20552-e20552 ◽

Cited By ~ 3

Author(s):

Donna Lynn Berry ◽

Fangxin Hong ◽

Traci Blonquist ◽

Barbara Halpenny ◽

Mary Lou Siefert ◽

...

Keyword(s):

Emergency Department ◽

Hospital Admissions ◽

Intervention Group ◽

Emergency Department Visits ◽

Self Report ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Unequal Variance ◽

Cancer Symptoms ◽

The Impact

e20552 Background: Attending to symptoms and side effects promotes safe and effective delivery of cancer therapies. Educated and supported patients (Pts) may be able to self-manage symptoms (Sx) and know when to contact the clinician, avoiding emergency department visits (EDV) or hospital admissions (HA). The web-based Electronic Self Report Assessment for Cancer (ESRA-C) is an easy-to-use, automated program for assessing and teaching about symptom and quality of life issues (SQI) and has been shown to improve communication and reduce symptom distress over the course of active therapy. The purpose of this secondary analysis was to explore the impact of the ESRA-C intervention on rates of EDV and HA. Methods: AdultPts with all cancer types and stages treated in medical and radiation oncology at a comprehensive cancer center used ESRA-C to self-report SQI during new anti-cancer therapy, with summary reports delivered to clinicians. Patients were randomized to assessment-only ESRA-C (control) or the ESRA-C intervention adding self-monitoring and education and coaching between clinic visits. We analyzed group differences on EDV and HA using descriptive statistics and a two group unequal variance t-test. Results: Among 663 Pts, 34 out of 327 control Pts made 47 EDV vs 30 out of 336 intervention Pts made 42 visits. Likewise, 36 control Pts had 59 HA vs 36 intervention Pts who had 41 HA during the study duration. The majority of EDV (87%) and HA (88%) were Sx-related. The frequency of Sx-related events (EDV or HA) was higher in the control (n=94) vs the intervention group (n=71). The mean number of unplanned events were 0.29 and 0.21 per patient in the control and intervention groups, respectively (p=0.24). Conclusions: Although the trial sample size was not planned to test differences in EDV or HA, the ESRA-C intervention, compared with assessment alone, may have reduced symptom-related EDV and HA in a large sample of patients during active cancer treatment. If we are able to reduce Sx-related unplanned visits and admissions from more than 1 of 4 patients to 1 of 5 patients with an automated, patient-centered system, we can anticipate substantial cost savings when scaled to the volume of most comprehensive cancer centers. Clinical trial information: NCT00852852.

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Effect of a supportive medicine program for cancer patients on patient connectivity to care and health care utilization.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2034 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2034-2034

Author(s):

Brooke Worster ◽

Gregory D. Garber ◽

Rebecca Cammy ◽

Liana Yocavitch ◽

Ayako Shimada ◽

...

Keyword(s):

Emergency Department ◽

Cancer Patients ◽

Hospital Admissions ◽

Cost Of Care ◽

Emergency Department Visits ◽

Comprehensive Cancer Center ◽

Categorical Variables ◽

Cancer Center ◽

Ed Visits ◽

The Impact

2034 Background: The benefits of supportive medicine (SM) for cancer patients include improved quality of life, increased patient satisfaction, improved symptom management, increased cost savings and improved survival rates. At one NCI-designated cancer center, all patients were screened for distress; those who screened positive or were directly referred by a provider were enrolled into our multi-disciplinary SM program. Here, we document the impact of the supportive medicine program on outcomes of emergency department (ED) visits, hospital readmission, and non-billable touchpoints associated with patient navigation and resource referrals. Methods: The program systematically screened for biopsychosocial distress utilizing the National Comprehensive Cancer Center Distress Thermometer (DT) and the Problem Checklist (PC) to identify practical, emotional, spiritual and physical issues. Patients were categorized into three types: screened and enrolled in the SM program, and screened and not enrolled in the SM program, or provider referral into the SM program. Data included patient’s age, number of hospital admissions, emergency department visits, and non-billable touchpoints at 90 and 180 days after the distress screening or referral. Descriptive data were analyzed with counts and percentages for categorical variables and summarized with mean and standard deviation for numerical variables. For investigation of the effects of time and patient type on the change in utilization rate, generalized estimation equations for Poisson regression were conducted for each outcome. Results: In all, 2,738 patients were included in the analysis. Patients who were referred from a provider tended to be younger (p < .01) and more likely to die within 90 days (p < .001). At 180 days, ED visits decreased 18% for patients referred to the SM program and 42% for patients screened into the SM program, compared to a 3% decrease in ED visits among those not enrolled in the SM program (p < .01). Similarly, hospital admissions decreased 34% for patients referred to and 39% screened into the SM program, compared to a 4% increase for patients not enrolled in the SM program (p < .01). Non-billable touchpoints increased among all types of patients. Conclusions: An SM program reduces hospital admissions and ED visits, therefore improving outcomes and potentially reducing the cost of care for cancer patients. Future research should link this data to claims data to definitely evaluate the impact of SM programs on cost.

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The impact of integrating an oncology nurse practitioner into an acute care hospital emergency department: An Australian tertiary cancer centre experience.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14029 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e14029-e14029

Author(s):

Gillian Blanchard ◽

Antonino Bonaventura ◽

Nicholas Dafters ◽

Fiona Day ◽

Craig Gedye ◽

...

Keyword(s):

Emergency Department ◽

Patient Care ◽

Acute Care ◽

Nurse Practitioner ◽

Acute Care Hospital ◽

Care Hospital ◽

Model Of Care ◽

New Model ◽

Oncology Nurse ◽

The Impact

e14029 Background: A significant delay in oncology patient journey through emergency department (ED) due to various reasons such as multiple specialists involved, difficulty in accessing timely advice from extremely busy inpatient/outpatient oncology teams, etc. In order to streamline admissions and discharges for oncology patients, a new model of care was created with the introduction of oncology nurse practitioner (ONP) at Calvary Mater Newcastle ED. This model operated during business hours three days a week with an aim to improve continuity of care, to enhance patients’ experience and meet organisations key performance indicators (KPIs). Limited research into the impact of these services on patient care and patient experience, particularly from service users’ perspective. Methods: A retrospective audit (6 months) has been undertaken to determine the impact of this model of care on time to specialty transfer, number of admissions versus discharges and patients representations through ED when ONP was available versus standard care. Results: During the audit period, ONP reviewed 149 patients. Fifty-four (36%) patients were discharged and of those 6 (11%) returned (within 28 days) with same or related issues. There was an average reduction in time to disposition planning for ED oncology patients of approximately 83 (193 vs 110) minutes when ONP was present at ED (one month review). Using a raw bed day costing, this resulted in a significant financial saving. Further cost analysis of this model is underway. Conclusions: The introduction of ONP into an acute care hospital ED has proven to be effective in terms of continuity of patient care, financial savings and assisted ED in meeting KPIs. The perception within the senior emergency management team is that this new model of care has been an unqualified success. ONP has rapidly and effectively joined emergency team and has seamlessly adjusted practice to the new environment. ED remains highly supportive of this new model of care. This model of care is one that could be translated easily to other specialities. Further analysis will be presented at the time of ASCO meeting.

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The impact of urgent care centers on nonemergent emergency department visits

Health Services Research ◽

10.1111/1475-6773.13631 ◽

2021 ◽

Author(s):

Lindsay Allen ◽

Janet R. Cummings ◽

Jason M. Hockenberry

Keyword(s):

Emergency Department ◽

Emergency Department Visits ◽

Urgent Care ◽

Urgent Care Centers ◽

The Impact

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Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design

BMC Health Services Research ◽

10.1186/s12913-021-06557-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Axel Kaehne ◽

Paula Keating

Keyword(s):

Emergency Department ◽

Service Use ◽

Emergency Department Visits ◽

Service Utilisation ◽

Specific Patient ◽

Access Points ◽

Latent Demand ◽

Frequent Attenders ◽

Cohort Design ◽

The Impact

Abstract Background Emergency department (ED) attendances are contributing to rising costs of the National Health Service (NHS) in England. Critically assessing the impact of new services to reduce emergency department use can be difficult as new services may create additional access points, unlocking latent demand. The study evaluated an Acute Visiting Scheme (AVS) in a primary care context. We asked if AVS reduces overall ED demand and whether or not it changed utilisation patterns for frequent attenders. Method The study used a pre post single cohort design. The impact of AVS on all-cause ED attendances was hypothesised as a substitution effect, where AVS duty doctor visits would replace emergency department visits. Primary outcome was frequency of ED attendances. End points were reduction of frequency of service use and increase of intervals between attendances by frequent attenders. Results ED attendances for AVS users rose by 47.6%. If AVS use was included, there was a more than fourfold increase of total service utilisation, amounting to 438.3%. It shows that AVS unlocked significant latent demand. However, there was some reduction in the frequency of ED attendances for some patients and an increase in time intervals between ED attendances for others. Conclusion The study demonstrates that careful analysis of patient utilisation can detect a differential impact of AVS on the use of ED. As the new service created additional access points for patients and hence introduces an element of choice, the new service is likely to unlock latent demand. This study illustrates that AVS may be most useful if targeted at specific patient groups who are most likely to benefit from the new service.

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Different levels of care for follow-up of adults with congenital heart disease: a cost analysis scrutinizing the impact on medical costs, hospitalizations, and emergency department visits

The European Journal of Health Economics ◽

10.1007/s10198-021-01300-5 ◽

2021 ◽

Author(s):

Ruben Willems ◽

◽

Fouke Ombelet ◽

Eva Goossens ◽

Katya De Groote ◽

...

Keyword(s):

Emergency Department ◽

Congenital Heart Disease ◽

Heart Disease ◽

Cost Analysis ◽

Congenital Heart ◽

Emergency Department Visits ◽

Levels Of Care ◽

The Impact ◽

Different Levels

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Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

Injury Epidemiology ◽

10.1186/s40621-021-00308-y ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Lauren Alexis De Crescenzo ◽

Barbara Alison Gabella ◽

Jewell Johnson

Keyword(s):

Public Health ◽

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Interrupted Time Series ◽

Emergency Department Visits ◽

Control And Prevention ◽

Icd 10 ◽

Ed Visits ◽

The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

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COVID-19: Stroke Admissions, Emergency Department Visits, and Prevention Clinic Referrals

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.101 ◽

2020 ◽

Vol 47 (5) ◽

pp. 693-696 ◽

Cited By ~ 12

Author(s):

Maria Bres Bullrich ◽

Sebastian Fridman ◽

Jennifer L. Mandzia ◽

Lauren M. Mai ◽

Alexander Khaw ◽

...

Keyword(s):

Emergency Department ◽

Stroke Prevention ◽

Stroke Unit ◽

Emergency Department Visits ◽

Related Factors ◽

Hospital Policies ◽

The Government ◽

Stroke Center ◽

The Impact ◽

Prevention Clinic

Abstract:We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London’s regional stroke center, serving a population of 1.8 million in Ontario, Canada. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.

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