Emergency department observational unit usage by patients with cancer: A retrospective review

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Jasmine King MA , Jason J. Bischof MD , Lauren T. Southerland MD
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引用次数: 0

Abstract

Background

Emergency department observation units (EDOUs) are effective and increasingly utilized in the delivery of short-term care. These units decrease length of stay and cost while increasing patient satisfaction and safety. Currently, EDOUs are underutilized for patients with cancer. We aimed to characterize the care of patients with cancer in an academic type 1 EDOU.

Methods

Retrospective review of EDOU quality data at an academic medical center with a Comprehensive Cancer Center (CCC). Eligible encounters included patients ≥ 18 cared for in the EDOU between July 1, 2019, and December 31, 2022. Patients with cancer were identified using an oncology triage screen during ED intake defined as a self-report of an active cancer or receiving care at the associated CCC. Descriptive statistics were employed to describe demographics, chief complaint, and assigned EDOU protocol. Pearson's chi-squared test was performed to determine statistically significant differences among patients with and without cancer. Due to dataset limitations, it was impossible to remove EDOU subjects with cancer treated for noncancer-related reasons.

Results

From 15,089 eligible EDOU encounters, 1,711 (11.3%) involved patients with cancer – 348, 548, 444, and 371 visits in 2019, 2020, 2021, and 2022 respectively. In the cohort with cancer, most patients were White (1,353, 79.1%) with a slight female predominance (905, 52.9%) noted. Furthermore, unspecified (148, 8.6%), chest pain (127, 7.4%), and abdominal pain (93, 5.4%) were the top chief complaints. In patients with cancer, 1,234 (72.1%) encounters resulted in discharge, significantly lower than that observed in patients without cancer (10,408, 77.8%; p<0.001). In both groups, the general observation protocol was the most utilized order set. However, further analysis revealed a significantly increased use of the general observation protocol in patients with cancer compared to noncancer patients (25.4% and 14.0%, respectively; p<0.001).

Conclusions

Compared to patients without cancer, patients with cancer experience a significantly higher use of the general observation protocol suggesting that further optimization and development of novel cancer-specific EDOU protocols is warranted.

癌症患者使用急诊科观察室的情况:回顾性研究
背景急诊科观察室(EDOUs)在提供短期护理方面非常有效,而且使用率越来越高。这些病房缩短了住院时间,降低了费用,同时提高了患者满意度和安全性。目前,急诊科观察室对癌症患者的利用率还很低。我们的目的是描述学术性 1 型 EDOU 对癌症患者的护理特点。方法回顾性审查一家设有综合癌症中心 (CCC) 的学术性医疗中心的 EDOU 质量数据。符合条件的病例包括2019年7月1日至2022年12月31日期间在EDOU接受治疗的≥18岁的患者。癌症患者是在急诊室接诊时通过肿瘤分诊筛查确定的,即自我报告患有活动性癌症或在相关 CCC 接受治疗的患者。描述性统计用于描述人口统计学、主诉和指定的 EDOU 方案。采用皮尔逊卡方检验来确定癌症患者和非癌症患者之间的显著统计学差异。由于数据集的限制,无法剔除因非癌症相关原因接受治疗的癌症 EDOU 受试者。结果在 15,089 次符合条件的 EDOU 就诊中,1,711 次(11.3%)涉及癌症患者,分别为 2019 年、2020 年、2021 年和 2022 年的 348 次、548 次、444 次和 371 次。在癌症患者群体中,大多数患者为白人(1353 人,占 79.1%),女性略占多数(905 人,占 52.9%)。此外,不明原因(148 人,占 8.6%)、胸痛(127 人,占 7.4%)和腹痛(93 人,占 5.4%)是最主要的主诉。癌症患者中有 1,234 人(72.1%)出院,明显低于非癌症患者(10,408 人,77.8%;p<0.001)。在两组患者中,一般观察方案是使用率最高的医嘱集。结论与非癌症患者相比,癌症患者对一般观察方案的使用率明显更高,这表明有必要进一步优化和开发新型癌症专用 EDOU 方案。
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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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