Comparing Care Delivery Efficiency Between Emergency Department and Oncology Urgent Care.

Q2 Social Sciences
Arthur S Hong, Sadaf Charania, Angela Bazzell, Mark Courtney, John W Sweetenham, Jason Fleming, Simon J Craddock Lee, Ethan A Halm
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Abstract

Introduction: Adults often visit the emergency department (ED) for complications from cancer treatment. Oncology urgent care clinics (UCCs) can manage nonemergent issues, but little is known about how UCC care compares with ED care.

Methods: The authors' university hospital ED and UCC visits (January 1, 2023, through June 30, 2023) were analyzed after coding the Emergency Severity Index (ESI) for UCC visits to make them comparable to ED visits, where ESI was already regularly assigned. ESI ranges from levels 1 to 5 (1 = highest severity). Coarsened exact matching and multivariate models were used to compare the proportion of patients discharged home, the length of stay, and advanced imaging use. Marginally adjusted outcomes were stratified by ESI.

Results: Prior to matching, 31.7% of UCC and 64.0% of ED visits were ESI level 2 severity; 61.0% of UCC and 33.4% of ED visits were ESI level 3. Matching resulted in 1033 UCC and 2782 ED visits (61.0% of patients > age 65; 47.8% female; 65.9% non-Hispanic White). In adjusted analyses, for ESI level 2 visits, the UCC discharged patients home 32.0% more often than the ED (95% confidence interval [CI], 27.5-36.4), with a 7.0-hour shorter length of stay (95% CI, 6.5-7.5), and used advanced imaging 30.3% less often (95% CI, 26.0-34.7). Findings were similar for ESI level 3 visits.

Discussion: The UCC managed a high level of severity and may be more efficient than the ED for nonemergent care.

Conclusion: Future work should more broadly investigate care delivery at each site, including the cost of care.

急诊科与肿瘤科急诊服务效率比较。
成人经常因癌症治疗并发症而到急诊科就诊。肿瘤紧急护理诊所(UCCs)可以处理非紧急问题,但对UCC护理与ED护理的比较知之甚少。方法:对作者的大学医院急诊科和UCC就诊(2023年1月1日至2023年6月30日)进行分析,并对UCC就诊的急诊严重程度指数(ESI)进行编码,使其与急诊科就诊(ESI已经定期分配)进行比较。ESI级别从1级到5级(1 =最高严重程度)。采用粗精确匹配和多变量模型比较出院患者比例、住院时间和高级影像学使用情况。边际调整结果采用ESI分层。结果:匹配前,31.7%的UCC和64.0%的ED就诊为ESI 2级;61.0%的UCC和33.4%的ED诊为ESI 3级。匹配结果为1033例UCC和2782例ED就诊(61.0%的患者年龄为65岁;47.8%的女性;65.9%非西班牙裔白人)。在调整后的分析中,对于ESI 2级就诊,UCC患者出院率比ED高32.0%(95%置信区间[CI], 27.5-36.4),住院时间短7.0小时(95% CI, 6.5-7.5),使用高级影像学的频率低30.3% (95% CI, 26.0-34.7)。ESI 3级访视的结果相似。讨论:UCC处理的严重程度较高,在非紧急护理方面可能比急诊科更有效。结论:未来的工作应更广泛地调查每个站点的护理服务,包括护理成本。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
The Permanente journal
The Permanente journal Medicine-Medicine (all)
CiteScore
2.20
自引率
0.00%
发文量
86
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