Patterns of Support Service, Emergency Department, and Hospital Utilization in Patients with Advanced Cancer: A Descriptive Study

2019 ◽  
Vol 35 (1) ◽  
pp. 34-39
Author(s):  
Caitlyn H. McNaughton ◽  
Michael Horst ◽  
Emily Gehron ◽  
Shanthi Sivendran ◽  
Julie Nguyen ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Support Services ◽  
Severe Disease ◽  
Community Setting ◽  
Retrospective Chart Review ◽  
Support Service ◽  
Advanced Cancer Patients ◽  
Individual Support ◽  
Nurse Navigator ◽  
Ed Visits

Context: Palliative care in oncology provides multiple benefits, however access to specialty palliative clinicians is limited in community cancer centers. Individual support services are more often available, but little is known on the utilization and impact of these services. Objectives: To describe the utilization of outpatient support services in the advanced cancer population and the association with ED and hospital use in a community setting. Methods: A retrospective chart review of 314 patients with advanced cancer of lung, gastrointestinal, genitourinary, and gynecologic origin was conducted. Data collected included demographics, descriptive data, type and number of support services (symptom management, nurse navigator, social worker, nutrition, financial counselor, chaplain, and oncology clinical counselor) within 90 days of diagnosis and descriptions of ED visits/hospitalizations within 12 months of diagnosis. Support services were available to patients by referral. Results: 29.6% of patients were deceased within 6 months and were considered to have severe disease. Patients with severe disease had a significantly greater mean number of support services than patients with non-severe disease (8.9 vs 6.0, p=0.001) and had a greater mean number of visits per year to the ED (6.4 vs 1.8, p<0.001). A greater proportion of patients with severe disease had palliative consultations (48.9% vs 21.7%, p<0.001), but 65.5% of palliative consultations occurred after an ED or hospital visit. Conclusion: Our data demonstrated that advanced cancer patients with severe disease had increased healthcare utilization in all areas measured. Despite high utilization, outpatient support services used in a reactive manner were not effective in reducing ED or hospital visits.

Utilization of support services, emergency department, and hospital in advanced cancer patients with severe disease in a community cancer institute.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 112-112
Author(s):  
Caitlyn McNaughton ◽  
Emily Gehron ◽  
Shanthi Sivendran ◽  
Rachel Holliday ◽  
Michael Horst ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Support Services ◽  
Symptom Management ◽  
Severe Disease ◽  
Hospital Utilization ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Ed Visits

112 Background: Patients with advanced cancer are at high risk for emergency department (ED) and hospital utilization, which is distressing and costly. Palliative care consultation and symptom management clinics have been shown to decrease ED and hospital utilization, but the frequency and composition of these interventions is still being delineated. More evaluation is needed to determine practical approaches to implementing interdisciplinary management of distress for patients with advanced cancer in the community setting. This retrospective review evaluates healthcare utilization with respect to support services provided in our community based cancer institute. Methods: 157 patients with advanced cancer of lung, gastrointestinal, genitourinary or gynecologic origin diagnosed January 2015-December 2015 were reviewed retrospectively. Descriptive data including demographics, disease characteristics, palliative care consultation, support services utilized and ED visits/hospitalizations were collected for 12 months, or to date of death. Support services included physician assistant–led symptom management, nurse navigator, social worker, nutrition, financial counselor, chaplain, and oncology clinical counselor. Support service referrals were made based on identified needs. Severe disease was defined as death within 6 months of diagnosis. Results: Patients with severe disease had a mean of 6 ED visits per year, significantly greater than patients with non-severe disease (p < 0.001). Patients with severe disease also had more contacts with support services per year (30.3 vs 9.1, p < 0.001). A palliative care consult was placed in 50% of patients with severe disease, and 23% in patients with non-severe disease (p < 0.001). Conclusions: Patients with advanced cancer have evidence of significant needs as reflected by high healthcare utilization in the last 6 months of life. As needed involvement of support services correlated with severity of disease but did not result in decreased ED utilization or hospitalization. This suggests that availability of support services alone is not a feasible strategy to impact unplanned hospitalizations and ED visits.

scholarly journals Causes of early postpartum complications that result in visits to the emergency department

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260101
Author(s):  
Prabhpreet Hundal ◽  
Rahim Valani ◽  
Cassandra Quan ◽  
Shayan Assaie-Ardakany ◽  
Tanmay Sharma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health System ◽  
Wound Care ◽  
Group B Streptococcus ◽  
Community Setting ◽  
Retrospective Chart Review ◽  
Postpartum Visit ◽  
Early Postpartum ◽  
Ed Visits ◽  
Group B

Objective This study aimed to review the reasons why postpartum women present to the emergency department (ED) over a short term (≤10 days post-delivery) and to identify the risk factors associated with early visits to the ED. Methods This retrospective chart review included all women who delivered at a regional health system (William Osler Health System, WOHS) in 2018 and presented to the WOHS ED within 10 days after delivery. Baseline descriptive statistics were used to examine the patient demographics and identify the timing of the postpartum visit. Univariate tests were used to identify significant predictors for admission. A multivariate model was developed based on backward selection from these significant factors to identify admission predictors. Results There were 381 visits identified, and the average age of the patients was 31.22 years (SD: 4.83), with median gravidity of 2 (IQR: 1–3). Most patients delivered via spontaneous vaginal delivery (53.0%). The median time of presentation to the ED was 5.0 days, with the following most common reasons: abdominal pain (21.5%), wound-related issues (12.6%), and urinary issues (9.7%). Delivery during the weekend (OR 1.91, 95% CI 1.00–3.65, P = 0.05) was predictive of admission while Group B Streptococcus positive patients were less likely to be admitted (OR 0.22, CI 0.05–0.97, P<0.05) Conclusions This was the first study in a busy community setting that examined ED visits over a short postpartum period. Patient education on pain management and wound care can reduce the rate of early postpartum ED visits.

scholarly journals Incidence and Cause of Delirium in Hospitalized Patients between the Ages of 18 and 56: A Retrospective Chart Review

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Michelle T. Weckmann ◽  
Camden Bay ◽  
Nesrin Abu Ata ◽  
R. Sean Morrison
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Total Hospital Cost ◽  
Advanced Cancer Patients ◽  
Total Hospital ◽  
Elderly Cancer Patients ◽  
Lung Malignancy ◽  
Distressing Condition

Background. Delirium is a common and devastating condition which has been well characterized in elderly cancer patients, but little is known about delirium in cancer patients under the age of 65. Aim. A pilot study to explore the incidence and potential causes of delirium in hospitalized advanced cancer patients at the age of 18–56 years. Design. A retrospective chart review using validated instruments was used to examine the charts of hematology-oncology admissions in a large academic institution. Data was collected as to the likelihood of delirium and potential precipitants. Results. Delirium incidence was 29% among advanced cancer patients. The associated precipitants of delirium were multifactorial, the most common being medications and infection. Delirium was more common in patients admitted for either acute symptom management or the presence of a lung malignancy. Patients with delirium demonstrated significantly increased total hospital cost and a borderline significant result for increased mortality compared to those without delirium. Conclusions. Delirium is common in hospitalized advanced cancer patients (age 18–56 years) and the cause is typically multifactorial. Delirium results in a more complicated hospital course and likely increased mortality. Further research is needed to define strategies to prevent and treat this common and distressing condition.

scholarly journals Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study

2021 ◽  
Vol 22 (6) ◽  
pp. 1270-1275
Author(s):  
Tinh Le ◽  
Parker Cordial ◽  
Mackenzie Sankoe ◽  
Charlotte Purnode ◽  
Ankur Parekh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Physician ◽  
Community Setting ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Similar Time ◽  
Initiation Point ◽  
Medication Assisted Treatment ◽  
Icd 10 ◽  
Ed Visits

Introduction: Recent studies from urban academic centers have shown the promise of emergency physician-initiated buprenorphine for improving outcomes in opioid use disorder (OUD) patients. We investigated whether emergency physician-initiated buprenorphine in a rural, community setting decreases subsequent healthcare utilization for OUD patients. Methods: We performed a retrospective chart review of patients presenting to a community hospital emergency department (ED) who received a prescription for buprenorphine from June 15, 2018–June 15, 2019. Demographic and opioid-related International Classification of Diseases, 10th Revision, (ICD-10) codes were documented and used to create a case-matched control cohort of demographically matched patients who presented in a similar time frame with similar ICD-10 codes but did not receive buprenorphine. We recorded 12-month rates of ED visits, all-cause hospitalizations, and opioid overdoses. Differences in event occurrences between groups were assessed with Poisson regression. Results: Overall 117 patients were included in the study: 59 who received buprenorphine vs 58 controls. The groups were well matched, both roughly 90% White and 60% male, with an average age of 33.4 years for both groups. Controls had a median two ED visits (range 0-33), median 0.5 hospitalizations (range 0-8), and 0 overdoses (range 0-3), vs median one ED visit (range 0-8), median 0 hospitalizations (range 0-4), and median 0 overdoses (range 0-3) in the treatment group. The incidence rate ratio (IRR) for counts of ED visits was 0.61, 95% confidence interval (CI), 0.49, 0.75, favoring medication-assisted treatment (MAT). For hospitalizations, IRR was 0.34, 95% CI, 0.22, 0.52 favoring MAT, and for overdoses was 1.04, 95% CI, 0.53, 2.07. Conclusion: Initiation of buprenorphine by ED providers was associated with lower 12-month ED visit and all-cause hospitalization rates with comparable overdose rates compared to controls. These findings show the ED’s potential as an initiation point for medication-assisted treatment in OUD patients.

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