Developing a new model of care for patients with cancer who present to the emergency department: The Mayo Clinic experience.

Authors

null

Debra A. Wong

Mayo Clinic, Scottsdale, AZ

Debra A. Wong, Tom R. Fitch, Eric Prommer, Yu-Hui Chang, Christopher A. Lipinski

Organizations

Mayo Clinic, Scottsdale, AZ

Research Funding

No funding sources reported

Background: Patients with cancer often have complex symptoms and morbidity that prompt frequent Emergency Department visits. The length of stay in the ED for cancer patients exceeds that of patients without cancer. Patients with cancer are also more likely to be admitted, but are often discharged within 72h. Protracted ED visits, extensive investigations, and the burdens of even a short admission may be distressing and may not be aligned with patients’ care goals and preferences. Furthermore, the healthcare resources dedicated to these patients is considerable and has economic implications. We recently established a Supportive Care Infusion Center (SCIC), an on-campus outpatient unit where patients can receive treatments for symptom relief and comfort; they are assured integrated palliative care with routine oncologic care. We believe there is a subset of cancer patients who can be safely transferred from the ED to the SCIC for appropriate care. Methods: We are retrospectively evaluating cancer patients admitted through the ED to validate clinical parameters likely to lead to admission, and also identify any differences between patients admitted for <72h vs >72h. Patients are analyzed based on symptoms, cancer type, prior cancer therapies, performance status, comorbidities, and presence/absence of advance care planning as well as previous contact with Palliative Care. Data are also being gathered on patient outcomes, including mortality within 60d of admission. Results: Previously established indicators predictive of admission included shortness of breath and SIRS criteria, which our current review validates. We also observe that patients admitted for >72h have greater symptom burden and comorbidities and have received multiple lines of therapy. They also less frequently have advance care planning in place. Data analysis is ongoing. Conclusions: There exists a difference between cancer patients admitted >72h and those discharged within 72h. Awareness of these characteristics may lead to improved workflow in the ED. Identifying patients who may be suitable for transfer to an outpatient supportive care unit rather than short-term admission will also facilitate cost-effectiveness. Future direction includes evaluation of outcomes such as mortality, quality of life, and patient-caregiver satisfaction.

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2014 Palliative and Supportive Care in Oncology Symposium

Session Type

Poster Session

Session Title

General Poster Session B: <span>Early Integration of Palliative Care in Cancer Care, Patient-Reported Outcomes, and Psycho-Oncology</span>

Track

Early Integration of Palliative Care in Cancer Care,Patient-Reported Outcomes: Mechanisms of Symptoms and Treatment Toxicities,Psycho-oncology,End-of-Life Care,Survivorship

Sub Track

Early Integration of Palliative Care in Cancer Care

Citation

J Clin Oncol 32, 2014 (suppl 31; abstr 61)

DOI

10.1200/jco.2014.32.31_suppl.61

Abstract #

61

Poster Bd #

C22

Abstract Disclosures

Similar Abstracts

First Author: Tiffany M. Statler

Abstract

2020 ASCO Quality Care Symposium

Identifying areas for quality improvement through outpatient mortality review.

First Author: Denise Gococo-Benore

First Author: Rubina Ratnaparkhi