Division of Hematology and Oncology, Stanford University and Stanford Cancer Institute, 269 Campus Drive, Center for Clinical Sciences Research (CCSR) Room 1136, Stanford, CA, 94305, USA.
Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Support Care Cancer. 2021 Jul;29(7):3571-3575. doi: 10.1007/s00520-020-05874-3. Epub 2020 Nov 7.
Oncology patients disproportionately utilize the emergency department (ED) for symptom management. At our institution, approximately 1 in 4 visits to the ED by oncology patients led to discharge. We hypothesized that many of the visits leading to ED discharge would be potentially preventable (PP).
We retrospectively characterized ED discharges of oncology patients. Visits were classified by presenting symptom, type of cancer, and time of ED visit. Chart reviewers were additionally asked whether each case could have been safely managed as an outpatient.
We analyzed 100 ED discharges in a 4-month period in 2016 and 2017. Gastrointestinal (GI) complaints, pain, and fever were the most common presenting symptoms for these visits. We rated 44 of 100 ED discharges as potentially preventable. Given we analyzed only ED discharges which comprise about 25% of ED visits for patients with cancer, overall about 10% of all ED visits by these patients may be preventable. We also found that ED visits without a clinic appointment or phone call to the clinic on the day of ED presentation were more likely to be preventable (51% vs 27%, OR 2.9, p = 0.026).
Many ED visits by oncology patients may be preventable and occur for symptoms which can be managed as an outpatient. More of these visits also appear to occur in those who do not reach a clinic member prior to the visit. These findings suggest that improved access to clinics and standardized outpatient symptom management are next steps to consider in preventing ED visits in this vulnerable population.
肿瘤患者不成比例地利用急诊部（ED）进行症状管理。在我们的机构中，大约每 4 名到 ED 就诊的肿瘤患者中就有 1 人出院。我们假设，导致 ED 出院的许多就诊都可能是可以预防的（PP）。
我们回顾性地描述了肿瘤患者的 ED 出院情况。就诊按就诊时的症状、癌症类型和 ED 就诊时间进行分类。病历审查员还被要求询问每个病例是否可以作为门诊患者安全管理。
我们分析了 2016 年和 2017 年 4 个月期间的 100 例 ED 出院患者。胃肠道（GI）投诉、疼痛和发热是这些就诊最常见的症状。我们将 100 例 ED 出院病例中的 44 例评为潜在可预防病例。由于我们只分析了占癌症患者 ED 就诊量约 25%的 ED 出院病例，因此这些患者的所有 ED 就诊量中约有 10%可能是可以预防的。我们还发现，ED 就诊当天没有预约诊所或打电话给诊所的可能性更大（51%比 27%，OR 2.9，p = 0.026）。
许多肿瘤患者的 ED 就诊可能是可以预防的，且发生的症状可以作为门诊患者进行管理。更多此类就诊似乎发生在就诊前未联系诊所成员的患者中。这些发现表明，改善对诊所的访问和标准化的门诊症状管理是下一步考虑的措施，以防止这一脆弱人群的 ED 就诊。
