A Systematic Review of Emergency Department Use Among Cancer Patients.
Rebecca S Lash, Janice F Bell, Sarah C Reed and 5 others
PMID 26925998WHAT IT FOUND
Adjusted 30-day emergency department visit rates among US cancer patients ranged from 1% to 2% for breast cancer to 7% to 12% for all cancers, but preventable use was unclear.
Key findings
01After adjusting to a 30-day frame, ED visit rates were 7% to 12% for all cancers, 5% to 12% for gynecological cancers, 2% to 10% for colon cancers, 3% to 5% for prostate cancers, 4% for lung cancers, and 1% to 2% for breast cancers.
02Eight studies assessed predictors and identified 14 significant predictors, but only comorbidity count was significant in more than 2 studies.
03Only one study quantified potentially preventable ED visits, classifying 8% of prostate, 7% of breast, 19% of lung, and 10% of colon cancer patient visits as potentially preventable.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The 15 included studies varied widely in aim, population, cancer type, design, and time frame. The 30-day adjustment assumes a constant ED visit rate over time, which may not fit patients with periodic or lengthy treatment. Many included studies likely undercount ED visits because they used patient recall, excluded admissions, counted only chemotherapy serious adverse events, or could not see visits at other hospitals. Only 3 predictors were found in more than 1 study, and only the number of comorbidities was significant in more than 2 studies. Reasons for ED visits were reported in only 5 studies and defined differently, so the review cannot say why patients visit the ED. Preventable ED use is unclear because only one study quantified it and most studies did not define it. The review included only US studies, excluded end-of-life ED use and studies of all patients with ED visits, and some included studies focused on specific subpopulations or used old data.
The easy way to misread this
Do not read these ED visit rates as proof that oncology care is failing or that a set percentage of visits is preventable. The review found inconsistent methods, likely undercounts, and unclear definitions of preventable ED use.