PURPOSE: There is little description of emergency department (ED) visits and subsequent hospitalizations among a safety-net cancer population. We characterized patterns of ED visits and explored nonclinical predictors of subsequent hospitalization, including time of ED arrival. PATIENTS AND METHODS: This was a retrospective cohort study of patients with cancer (excluding leukemia and nonmelanoma skin cancer) between 2012 and 2016 at a large county urban safety-net health system. We identified ED visits occurring within 180 days after a cancer diagnosis, along with subsequent hospitalizations (observation stay or inpatient admission). We used mixed-effects multivariable logistic regression to model hospitalization at ED disposition, accounting for variability across patients and emergency physicians. RESULTS: The 9,050 adults with cancer were 77.2% nonwhite and 55.0% female. Nearly one-quarter (24.7%) of patients had advanced-stage cancer at diagnosis, and 9.7% died within 180 days of diagnosis. These patients accrued 11,282 ED visits within 180 days of diagnosis. Most patients had at least one ED visit (57.7%); half (49.9%) occurred during business hours (Monday through Friday, 8:00 am to 4:59 pm), and half (50.4%) resulted in hospitalization. More than half (57.5%) of ED visits were for complaints that included: pain/headache, nausea/vomiting/dehydration, fever, swelling, shortness of breath/cough, and medication refill. Patients were most often discharged home when they arrived between 8:00 am and 11:59 am (adjusted odds ratio for hospitalization, 0.69; 95% CI, 0.56 to 0.84). CONCLUSION: ED visits are common among safety-net patients with newly diagnosed cancer, and hospitalizations may be influenced by nonclinical factors. The majority of ED visits made by adults with newly diagnosed cancer in a safety-net health system could potentially be routed to an alternate site of care, such as a cancer urgent care clinic.
PURPOSE: There is little description of emergency department (ED) visits and subsequent hospitalizations among a safety-net cancer population. We characterized patterns of ED visits and explored nonclinical predictors of subsequent hospitalization, including time of ED arrival. PATIENTS AND METHODS: This was a retrospective cohort study of patients with cancer (excluding leukemia and nonmelanoma skin cancer) between 2012 and 2016 at a large county urban safety-net health system. We identified ED visits occurring within 180 days after a cancer diagnosis, along with subsequent hospitalizations (observation stay or inpatient admission). We used mixed-effects multivariable logistic regression to model hospitalization at ED disposition, accounting for variability across patients and emergency physicians. RESULTS: The 9,050 adults with cancer were 77.2% nonwhite and 55.0% female. Nearly one-quarter (24.7%) of patients had advanced-stage cancer at diagnosis, and 9.7% died within 180 days of diagnosis. These patients accrued 11,282 ED visits within 180 days of diagnosis. Most patients had at least one ED visit (57.7%); half (49.9%) occurred during business hours (Monday through Friday, 8:00 am to 4:59 pm), and half (50.4%) resulted in hospitalization. More than half (57.5%) of ED visits were for complaints that included: pain/headache, nausea/vomiting/dehydration, fever, swelling, shortness of breath/cough, and medication refill. Patients were most often discharged home when they arrived between 8:00 am and 11:59 am (adjusted odds ratio for hospitalization, 0.69; 95% CI, 0.56 to 0.84). CONCLUSION: ED visits are common among safety-net patients with newly diagnosed cancer, and hospitalizations may be influenced by nonclinical factors. The majority of ED visits made by adults with newly diagnosed cancer in a safety-net health system could potentially be routed to an alternate site of care, such as a cancer urgent care clinic.
Authors: Amanda Digel Vandyk; Margaret B Harrison; Gail Macartney; Amanda Ross-White; Dawn Stacey Journal: Support Care Cancer Date: 2012-04-17 Impact factor: 3.603
Authors: Gabriel A Brooks; Thomas A Abrams; Jeffrey A Meyerhardt; Peter C Enzinger; Karen Sommer; Carole K Dalby; Hajime Uno; Joseph O Jacobson; Charles S Fuchs; Deborah Schrag Journal: J Clin Oncol Date: 2014-01-13 Impact factor: 44.544
Authors: Graham P Martin; Brad Wright; Azeemuddin Ahmed; Jay Banerjee; Suzanne Mason; Damian Roland Journal: Ann Emerg Med Date: 2016-11-23 Impact factor: 5.721
Authors: Scott D Ramsey; Aasthaa Bansal; Catherine R Fedorenko; David K Blough; Karen A Overstreet; Veena Shankaran; Polly Newcomb Journal: J Clin Oncol Date: 2016-01-25 Impact factor: 44.544
Authors: Arthur S Hong; Danh Q Nguyen; Simon Craddock Lee; D Mark Courtney; John W Sweetenham; Navid Sadeghi; John V Cox; Hannah Fullington; Ethan A Halm Journal: JCO Oncol Pract Date: 2021-05-26
Authors: Arthur S Hong; Hannah Chang; D Mark Courtney; Hannah Fullington; Simon J Craddock Lee; John W Sweetenham; Ethan A Halm Journal: JCO Oncol Pract Date: 2021-01-08
Authors: Ryan D Nipp; Eliza Shulman; Melissa Smith; Patricia M C Brown; P Connor Johnson; Eva Gaufberg; Charu Vyas; Carolyn L Qian; Isabel Neckermann; Shira B Hornstein; Mathew J Reynolds; Joseph Greer; Jennifer S Temel; Areej El-Jawahri Journal: BMC Cancer Date: 2022-04-09 Impact factor: 4.430