J Pain Symptom Manage. 2014 Aug 14. pii: S0885-3924(14)00404-7. doi: 10.1016/j.jpainsymman.2014.07.007. [Epub ahead of print]
Delgado-Guay MO, Kim YJ, Shin SH, Chisholm G, Williams J, Allo J, Bruera E
Using information from 200 randomly selected advanced cancer patients receiving outpatient palliative care who visited the Emergency Department (from a pool of nearly 2000), this study investigated the frequency and clinical characteristics of potentially avoidable Emergency Department visits. A visit was considered avoidable if the problem could have been managed in the outpatient clinic or by telephone. Of the 200 patient visits, 46 (23%) Emergency Department visits were thought to be avoidable. This was less than the hypothesised amount which was over 50%. Pain was the most common complaint in both avoidable and unavoidable visits (36%). Altered mental status, dyspnoea, fever, and bleeding were present in the unavoidable group only. Constipation and running out of analgesics were more frequent in the avoidable group. In a multivariate analysis, avoidable attendance was associated with non-white ethnicity and constipation, whereas unavoidable attendance was associated with Emergency Department referral from the outpatient oncology or palliative care clinic, and the presence of baseline dyspnoea. The authors suggest that efforts are needed to improve communication with patients and caregivers and increase support between appointments to reduce avoidable Emergency Department visits. Furthermore, with increased community services and collaboration between services even the unavoidable Emergency Department visits might be reduced.