Preventing emergency department visits among patients with cancer: a scoping review

Data was extracted from publicly available data from studies that were included in this scoping review. Extracted data included descriptive outcomes and outcome data regarding emergency department utilization

Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs

Introduction This study examined emergency department (ED) presentations of patients with end of life (EOL) conditions and patients having met and unmet palliative care needs were compared. Methods Presentations for EOL conditions were prospectively identified and screened for palliative care needs. Descriptive data were reported as proportions, means or medians. Bi-variable analysis for dichotomous and continuous variables were performed by chi-squared and T-tests (p≤0.01), respectively. A multivariable logistic regression model identified factors associated with having unmet palliative needs and reported adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results Overall, 663 presentations for EOL conditions were identified; 518 (78%) involved patients with unmet palliative care needs. Presentations by patients with unmet palliative needs were more likely to involve consultations (80% vs. 67%, p = 0.001) and result in hospitalization (69% vs. 51%, p&lt;0.001) compared to patients whose palliative needs were met. Patients with unmet palliative care needs were more likely to have previous ED visits (73% unmet vs. 48% met; p&lt;0.001). While medication, procedures, investigations and imaging ordering were high across all patients with EOL conditions, there were no significant differences between the groups. Consultations with palliative specialists in the ED (6% unmet vs. 1% met) and following discharge (29% unmet vs. 18% met) were similarly uncommon. Patients having two or more EOL conditions (aOR = 2.41; 95% CI: 1.16, 5.00), requiring hospitalization (aOR = 1.93; 95% CI: 1.30, 2.87), and dying during the ED visit (aOR = 2.15; 95% CI: 1.02, 4.53) were strongly associated with having unmet palliative care needs. Conclusions Most ED presentations for EOL conditions were made by patients with unmet palliative care needs, who were significantly more likely to require consultation, hospitalization, and to die. Referrals to palliative care services during and after the ED visit were infrequent, indicating important opportunities to promote these services. </jats:sec

Disposition and post-discharge referrals of 663 emergency department presentations by patients with end-of-life conditions compared on unmet vs. met palliative care needs.

Disposition and post-discharge referrals of 663 emergency department presentations by patients with end-of-life conditions compared on unmet vs. met palliative care needs.</p

Emergency department management of 663 presentations by patients with end-of-life conditions compared on unmet vs. met palliative care needs.

Emergency department management of 663 presentations by patients with end-of-life conditions compared on unmet vs. met palliative care needs.</p

Factors included in a modified screening tool to identify met or unmet palliative care needs among 663 presentations to the emergency department by patients with end-of-life conditions.

Factors included in a modified screening tool to identify met or unmet palliative care needs among 663 presentations to the emergency department by patients with end-of-life conditions.</p