Abstract
IntroductionThere is increasing appreciation of the challenges of providing safe and appropriate care to cancer patients in the emergency department (ED). Our goal here was to assess which patient characteristics are associated with more frequent ED revisits.MethodsThis was a retrospective cohort study of all ED visits in California during the 2016 calendar year using data from the California Office of Statewide Health Planning and Development. We defined revisits as a return visit to an ED within seven days of the index visit. For both index and return visits, we assessed various patient characteristics, including age, cancer type, medical comorbidities, and ED disposition.ResultsAmong 12.9 million ED visits, we identified 73,465 adult cancer patients comprising 103,523 visits that met our inclusion criteria. Cancer patients had a 7-day revisit rate of 17.9% vs 13.2% for non-cancer patients. Cancer patients had a higher rate of admission upon 7-day revisit (36.7% vs 15.6%). Patients with cancers of the small intestine, stomach, and pancreas had the highest rate of 7-day revisits (22–24%). Cancer patients younger than 65 had a higher 7-day revisit rate than the elderly (20.0% vs 16.2%).ConclusionIn a review of all cancer-related ED visits in the state of California, we found a variety of characteristics associated with a higher rate of 7-day ED revisits. Our goal in this study was to inform future research to identify interventions on the index visit that may improve patient outcomes.
Highlights
There is increasing appreciation of the challenges of providing safe and appropriate care to cancer patients in the emergency department (ED)
In a review of all cancer-related ED visits in the state of California, we found a variety of characteristics associated with a higher rate of 7-day ED revisits
There is a dearth of information regarding the epidemiology of those cancer patients who visit the ED and which factors lead to ED revisits
Summary
There is increasing appreciation of the challenges of providing safe and appropriate care to cancer patients in the emergency department (ED). Providing emergency care to cancer patients presents a unique set of challenges for the healthcare system. In 2015 the National Institutes of Health established a consortium to advance knowledge in this area, with one specific, highlighted aim as the collection of epidemiologic data.[1] According to the 2015 National Hospital Ambulatory Medical Care Survey, cancer patients accounted for 3.4% of emergency department (ED) visits across all age groups.[2] A recently published survey found that patients with cancer who present to the ED are more likely to be older, experience prolonged ED stays, and be admitted.[3] there is a dearth of information regarding the epidemiology of those cancer patients who visit the ED and which factors lead to ED revisits. The short-term revisit rate is an increasingly analyzed quality metric as it is associated with worse outcomes, including morbidity and mortality.[4,5,6,7] these early revisits may represent medical errors or failures in the healthcare delivery model and can help recognize targets for intervention.[8]
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