Joshi Amit, Patil Vijay M, Noronha Vanita, Ramaswamy Anant, Gupta Sudeep, Bhattacharjee Atanu, Bonda Avinash, Chandrakanth M V, Ostwal Vikas, Khattry Navin, Banavali Shripad, Prabhash Kumar
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.
Chiltern International, Bengaluru, Karnataka, India.
South Asian J Cancer. 2017 Oct-Dec;6(4):186-189. doi: 10.4103/sajc.sajc_128_17.
We are a tertiary care cancer center and have approximately 1000-1500 emergency visits by cancer patients undergoing treatment under the adult medical oncology unit each month. However, due to the lack of a systematic audit, we are unable to plan steps toward the improvement in quality of emergency services, and hence the audit was planned.
All emergency visits under the adult medical oncology department in the month of July 2015 were audited. The cause of visit, the demographic details, cancer details, and chemotherapy status were obtained from the electronic medical records. The emergency visits were classified as avoidable or unavoidable. Descriptive statistics were performed. Reasons for avoidable emergency visits were sought.
Out of 1199 visits, 1168 visits were classifiable. Six hundred and ninety-six visits were classified as unavoidable (59.6%, 95% CI: 56.7-62.4), 386 visits were classified as probably avoidable visit (33.0%, 95% CI: 30.4-35.8) whereas the remaining 86 (7.4%, 95% CI: 6.0-9.01) were classified as absolutely avoidable. Two hundred and ninety-seven visits happened on weekends (25.6%) and 138 visits converted into an inpatient admission (11.9%). The factors associated with avoidable visits were curative intention of treatment (odds ratio - 2.49), discontinued chemotherapy status (risk ratio [RR] - 8.28), and private category file status (RR - 1.89).
A proportion of visits to emergency services can be curtailed. Approximately one-fourth of patients are seen on weekends, and only about one-tenth of patients get admitted.
我们是一家三级医疗癌症中心，每月约有1000 - 1500名成年肿瘤内科接受治疗的癌症患者前来急诊。然而，由于缺乏系统的审核，我们无法规划提高急诊服务质量的措施，因此计划进行此次审核。
对2015年7月成年肿瘤内科的所有急诊就诊情况进行审核。从电子病历中获取就诊原因、人口统计学细节、癌症详情和化疗状态。将急诊就诊分为可避免或不可避免两类。进行描述性统计分析，并查找可避免急诊就诊的原因。
在1199次就诊中，1168次可分类。696次就诊被分类为不可避免（59.6%，95%可信区间：56.7 - 62.4），386次就诊被分类为可能可避免（33.0%，95%可信区间：30.4 - 35.8），而其余86次（7.4%，95%可信区间：6.0 - 9.01）被分类为绝对可避免。297次就诊发生在周末（25.6%），138次就诊转为住院（11.9%）。与可避免就诊相关的因素有治疗的治愈意图（优势比 - 2.49）、化疗中断状态（风险比[RR] - 8.28）和私立类别档案状态（RR - 1.89）。
一部分急诊服务就诊可以减少。约四分之一的患者在周末就诊，只有约十分之一的患者住院。
