Skip to main content
Top
Published in: Supportive Care in Cancer 1/2016

01-01-2016 | Original Article

Unplanned oncology admissions within 14 days of non-surgical discharge: a retrospective study

Authors: Samantha Gibson, Ruth McConigley

Published in: Supportive Care in Cancer | Issue 1/2016

Login to get access

Abstract

Aim

The aim of this study was to identify the incidence, causes, risk factors and interventions for cancer patients requiring unplanned admissions within 14 days of discharge at a large metropolitan private hospital without a co-located emergency department.

Methods

Retrospective data were collected on cancer patients who had an unplanned admission within 14 days of discharge during the period December 1, 2011 and May 31, 2012. Data were collected from the inpatient bed administration database and medical record review. Variables collected included demographics, cancer diagnosis, reasons for admission, interventions, and length of stay.

Results

A total of 133 oncology patients required 206 unplanned admissions (UPAs). The most common cancer diagnoses associated with unplanned readmission were upper gastrointestinal (25.4 %), colorectal (19.6 %), gynaecological (18.8 %) and breast (13.8 %) cancers. The symptoms most commonly associated with unplanned re-admission were pain (16 %); infection not associated with neutropaenia (15.5 %); fever and febrile neutropaenia (14.6 %); nausea, vomiting and dehydration (13.6 %); dyspnoea (8.3 %) and altered neurological status (7.8 %). The median length of stay (LOS) was 6 days. Length of stay during UPA was decreased for patients with a partner and for those who had a palliative care consult. The need for psychological supports was related to a longer LOS during UPA.

Conclusion

Cancer patients are at a significant risk of requiring unscheduled care and admission. Strategies and services to limit the burden on patients and the health care system should be reviewed to minimise the incidence of unplanned admission.
Literature
1.
go back to reference McKenzie H, Hayes L, White K, Cox K, Fethney J, Boughton M, Dunn J (2010) Chemotherapy outpatients’ unplanned presentations to hospital: a retrospective study. Support Care Cancer 19:963–969CrossRefPubMed McKenzie H, Hayes L, White K, Cox K, Fethney J, Boughton M, Dunn J (2010) Chemotherapy outpatients’ unplanned presentations to hospital: a retrospective study. Support Care Cancer 19:963–969CrossRefPubMed
2.
go back to reference Hassett MJ, O’Malley AJ, Pakes JR, Newhouse JP, Earle CC (2006) Frequency and cost of chemotherapy-related serious adverse effects in a population sample of women with breast cancer. J Natl Cancer Inst 98(16):1108–1117CrossRefPubMed Hassett MJ, O’Malley AJ, Pakes JR, Newhouse JP, Earle CC (2006) Frequency and cost of chemotherapy-related serious adverse effects in a population sample of women with breast cancer. J Natl Cancer Inst 98(16):1108–1117CrossRefPubMed
3.
go back to reference Livingston PM, Craike M, Considine J (2011) Unplanned presentation to emergency departments due to chemotherapy induced complications: opportunities for improving service delivery. Aust Emerg Nurs J 14:62–68CrossRef Livingston PM, Craike M, Considine J (2011) Unplanned presentation to emergency departments due to chemotherapy induced complications: opportunities for improving service delivery. Aust Emerg Nurs J 14:62–68CrossRef
4.
go back to reference Mitchell T (2007) The social and emotional toll of chemotherapy—patients’ perspectives. Eur J Cancer Care 16:39–47CrossRef Mitchell T (2007) The social and emotional toll of chemotherapy—patients’ perspectives. Eur J Cancer Care 16:39–47CrossRef
6.
go back to reference Henretta MS, Scalici JM, Engelhard CL, Duska LR (2011) The revolving door: hospital readmissions of gynaecologic oncology patients. Gynecol Oncol 122:479–483CrossRefPubMed Henretta MS, Scalici JM, Engelhard CL, Duska LR (2011) The revolving door: hospital readmissions of gynaecologic oncology patients. Gynecol Oncol 122:479–483CrossRefPubMed
7.
8.
go back to reference Cohen L, de Moor CA, Eisenberg P, Ming EE, Hu H (2007) Chemotherapy-induced nausea and vomiting—incidence and impact on patient quality of life at community oncology settings. Support Care Cancer 15:497–503CrossRefPubMed Cohen L, de Moor CA, Eisenberg P, Ming EE, Hu H (2007) Chemotherapy-induced nausea and vomiting—incidence and impact on patient quality of life at community oncology settings. Support Care Cancer 15:497–503CrossRefPubMed
9.
go back to reference Fromme EK, Eilers KM, Mori M, Hsieh Y-C, Beer TM (2004) How accurate is clinical reporting of chemotherapy adverse effects? A comparison with patient-reported symptoms from the quality-of-life questionnaire C30. J Clin Oncol 22(17):3485–3490CrossRefPubMed Fromme EK, Eilers KM, Mori M, Hsieh Y-C, Beer TM (2004) How accurate is clinical reporting of chemotherapy adverse effects? A comparison with patient-reported symptoms from the quality-of-life questionnaire C30. J Clin Oncol 22(17):3485–3490CrossRefPubMed
10.
go back to reference Considine J, Livingston P, Bucknall T, Botti M (2009) A review of the role of emergency nurses in management of chemotherapy-related complications. J Clin Nurs 18:2649–2655CrossRefPubMed Considine J, Livingston P, Bucknall T, Botti M (2009) A review of the role of emergency nurses in management of chemotherapy-related complications. J Clin Nurs 18:2649–2655CrossRefPubMed
11.
go back to reference Martin CG, Kennedy KF, Elting LS, Manzullo EM, Escalante CP, Rubenstein EB (1996) Incidence of emergency visits among oncology patients receiving outpatient chemotherapy: implications for care in a capitated market. Cancer Control 3(5):435–441PubMed Martin CG, Kennedy KF, Elting LS, Manzullo EM, Escalante CP, Rubenstein EB (1996) Incidence of emergency visits among oncology patients receiving outpatient chemotherapy: implications for care in a capitated market. Cancer Control 3(5):435–441PubMed
12.
go back to reference Tas F, Argon A, Disci R, Topuz E (2007) Pattern and outcome of admission to a medical oncology inpatient service. J Cancer Educ 22(2):80–85CrossRefPubMed Tas F, Argon A, Disci R, Topuz E (2007) Pattern and outcome of admission to a medical oncology inpatient service. J Cancer Educ 22(2):80–85CrossRefPubMed
13.
go back to reference Nirenberg A, Mulhearn L, Lin S, Larson E (2004) Emergency department waiting times for patients with febrile neutropaenia: a pilot study. Oncol Nurs Forum 31(4):711–715CrossRefPubMed Nirenberg A, Mulhearn L, Lin S, Larson E (2004) Emergency department waiting times for patients with febrile neutropaenia: a pilot study. Oncol Nurs Forum 31(4):711–715CrossRefPubMed
14.
go back to reference Callen JL, Blundell L, Prgomet M (2008) Emergency department use in a rural Australian setting: are factors prompting attendance appropriate? Aust Health Rev 32(4):710–720CrossRefPubMed Callen JL, Blundell L, Prgomet M (2008) Emergency department use in a rural Australian setting: are factors prompting attendance appropriate? Aust Health Rev 32(4):710–720CrossRefPubMed
15.
go back to reference Diaz-Couselo FA, OÇonnor MJ, Nervo A, Tossen G, Guercovich A, Puparelli C, Zylberman M (2004) Nonscheduled consultation in oncologic patients. How many of these are true emergencies? An observational prospective study? Support Care Cancer 12:274–277CrossRefPubMed Diaz-Couselo FA, OÇonnor MJ, Nervo A, Tossen G, Guercovich A, Puparelli C, Zylberman M (2004) Nonscheduled consultation in oncologic patients. How many of these are true emergencies? An observational prospective study? Support Care Cancer 12:274–277CrossRefPubMed
16.
go back to reference Craike MJ, Livingston PM, Considine M (2010) Emergency department presentations of patients from CALDB receiving chemotherapy in day oncology settings. Aust Emerg Nurs J 13:111–116CrossRef Craike MJ, Livingston PM, Considine M (2010) Emergency department presentations of patients from CALDB receiving chemotherapy in day oncology settings. Aust Emerg Nurs J 13:111–116CrossRef
17.
go back to reference Bozdemir N, Eray A, Senol Y, Artac M, Samur M (2009) Demographics, clinical presentations and outcomes of cancer patients admitted to the emergency department. Turk J Med Sci 39(2):235–240 Bozdemir N, Eray A, Senol Y, Artac M, Samur M (2009) Demographics, clinical presentations and outcomes of cancer patients admitted to the emergency department. Turk J Med Sci 39(2):235–240
18.
go back to reference Majem M, Galan M, Perez FJ, Munoz M, Chicote S, Soler G, Germa JR (2007) The oncology acute toxicity unit (OATU): an outpatient facility for improving the management of chemotherapy toxicity. Clin Transl Oncol 9:784–788CrossRefPubMed Majem M, Galan M, Perez FJ, Munoz M, Chicote S, Soler G, Germa JR (2007) The oncology acute toxicity unit (OATU): an outpatient facility for improving the management of chemotherapy toxicity. Clin Transl Oncol 9:784–788CrossRefPubMed
20.
go back to reference Tsai S-C, Liu L-N, Tang S-T, Chen J-C, Chen M-L (2010) Cancer pain as the presenting problem in emergency departments: incidence and related factors. Support Care Cancer 18:57–65CrossRefPubMed Tsai S-C, Liu L-N, Tang S-T, Chen J-C, Chen M-L (2010) Cancer pain as the presenting problem in emergency departments: incidence and related factors. Support Care Cancer 18:57–65CrossRefPubMed
21.
go back to reference Dennis K, Librach SL, Chow E (2011) Palliative care and oncology: integration leads to better care. Oncology (Williston Park) 25:1271–1275 Dennis K, Librach SL, Chow E (2011) Palliative care and oncology: integration leads to better care. Oncology (Williston Park) 25:1271–1275
22.
go back to reference Brunetto AT, Ang JE, Olmos D, Tan D, Bariuso J, Arkenau H-T, Kaye S (2010) A study of the pattern of hospital admissions in a specialist phase I oncology trials unit: unplanned admissions as an early indicator of patient attrition. Eur J Cancer 46:2739–2745CrossRefPubMed Brunetto AT, Ang JE, Olmos D, Tan D, Bariuso J, Arkenau H-T, Kaye S (2010) A study of the pattern of hospital admissions in a specialist phase I oncology trials unit: unplanned admissions as an early indicator of patient attrition. Eur J Cancer 46:2739–2745CrossRefPubMed
23.
go back to reference Weaver C, Schiech L, Held-Warmkessel J, Kadziera P, Haney E, DiLullo G, Barsevick A (2006) Risk of unplanned hospital readmission of patients with cancer: results of a retrospective medical record review. Oncol Nurs Forum 33(3):E44–E52CrossRefPubMed Weaver C, Schiech L, Held-Warmkessel J, Kadziera P, Haney E, DiLullo G, Barsevick A (2006) Risk of unplanned hospital readmission of patients with cancer: results of a retrospective medical record review. Oncol Nurs Forum 33(3):E44–E52CrossRefPubMed
24.
go back to reference deBoer A, Wijker W, de Haes H (1997) Predictors of health care utilization in the chronically ill: a review of the literature. Health Policy 42(2):101–115CrossRef deBoer A, Wijker W, de Haes H (1997) Predictors of health care utilization in the chronically ill: a review of the literature. Health Policy 42(2):101–115CrossRef
25.
go back to reference Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, Bergman H (2010) Does frailty predict hospitalization, emergency department visits and visits to the general practitioner in older newly-diagnosed cancer patients? Results of a prospective pilot study. Crit Rev Oncol Hematol 76:142–151CrossRefPubMed Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, Bergman H (2010) Does frailty predict hospitalization, emergency department visits and visits to the general practitioner in older newly-diagnosed cancer patients? Results of a prospective pilot study. Crit Rev Oncol Hematol 76:142–151CrossRefPubMed
26.
go back to reference Yates M, Barrett A (2009) Oncological emergency admissions to the Norfolk and Norwich university hospital: an audit of current arrangements and patient satisfaction. Clin Oncol 21:226–233CrossRef Yates M, Barrett A (2009) Oncological emergency admissions to the Norfolk and Norwich university hospital: an audit of current arrangements and patient satisfaction. Clin Oncol 21:226–233CrossRef
27.
go back to reference Du XL, Osborne C, Goodwin JS (2002) Population-based assessment of hospitalizations for toxicity from chemotherapy in older women with breast cancer. J Clin Oncol 20(24):4636–4642PubMedCentralCrossRefPubMed Du XL, Osborne C, Goodwin JS (2002) Population-based assessment of hospitalizations for toxicity from chemotherapy in older women with breast cancer. J Clin Oncol 20(24):4636–4642PubMedCentralCrossRefPubMed
28.
go back to reference Lai JK, Martin MA, Meyricke R, O’Neill T, Roberts S (2007) Factors associated with short-term hospital readmission rates for breast cancer patients in western Australia: an observational study. J Am Coll Surg 204(2):193–200CrossRefPubMed Lai JK, Martin MA, Meyricke R, O’Neill T, Roberts S (2007) Factors associated with short-term hospital readmission rates for breast cancer patients in western Australia: an observational study. J Am Coll Surg 204(2):193–200CrossRefPubMed
29.
go back to reference Molassiotis A, Brearly S, Saunders M, Craven O, Wardley A, Farrell C, Luker K (2008) Effectiveness of a home care nursing program in the symptom management of patients with colorectal and breast cancer receiving oral chemotherapy: a randomized control trial. J Clin Oncol 27(36):6191–6197CrossRef Molassiotis A, Brearly S, Saunders M, Craven O, Wardley A, Farrell C, Luker K (2008) Effectiveness of a home care nursing program in the symptom management of patients with colorectal and breast cancer receiving oral chemotherapy: a randomized control trial. J Clin Oncol 27(36):6191–6197CrossRef
30.
go back to reference Graham D and McKerrow J (2006) Frequency of urgent/emergency symptoms assessed by triaging nurse for oncology patients seeking treatment at a comprehensive cancer centre. ONS Congress Abstract 2006 Graham D and McKerrow J (2006) Frequency of urgent/emergency symptoms assessed by triaging nurse for oncology patients seeking treatment at a comprehensive cancer centre. ONS Congress Abstract 2006
31.
go back to reference Miranda V, Fede A, Nobuo M, Ayres V, Giglio A, Miranda M, Riechalmann MD (2011) Adverse drug reactions and drug interactions as causes of hospital admission in oncology. J Pain Symptom Manag 42(3):342–353CrossRef Miranda V, Fede A, Nobuo M, Ayres V, Giglio A, Miranda M, Riechalmann MD (2011) Adverse drug reactions and drug interactions as causes of hospital admission in oncology. J Pain Symptom Manag 42(3):342–353CrossRef
32.
go back to reference Courtney MD, Aldeen AZ, Gorman SM, Handler JA, Trifilio SM, Parada JP, Bennett CL (2007) Cancer- associated neutropenic fever: clinical outcome and economic costs of emergency department care. Oncologist 12:1019–1026CrossRefPubMed Courtney MD, Aldeen AZ, Gorman SM, Handler JA, Trifilio SM, Parada JP, Bennett CL (2007) Cancer- associated neutropenic fever: clinical outcome and economic costs of emergency department care. Oncologist 12:1019–1026CrossRefPubMed
33.
go back to reference Lim JH, Kim H, Choi WG, Kim KH, Shin DW, Lee MH (2011) Outcomes in 102 patients that presented to the emergency department with chemotherapy-induced febrile neutropaenia. Turk J Hematol 28:193–197CrossRef Lim JH, Kim H, Choi WG, Kim KH, Shin DW, Lee MH (2011) Outcomes in 102 patients that presented to the emergency department with chemotherapy-induced febrile neutropaenia. Turk J Hematol 28:193–197CrossRef
34.
go back to reference Klatersky J, Paesmans M, Georgala A, Muanza F, Plehiers B, Dubreucq L, Barette M (2006) Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol 24(25):4129–4134CrossRef Klatersky J, Paesmans M, Georgala A, Muanza F, Plehiers B, Dubreucq L, Barette M (2006) Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol 24(25):4129–4134CrossRef
35.
go back to reference Innes H, Marshall E (2007) Outpatient therapy for febrile neutropaenia. Curr Opin Oncol 19:294–298PubMed Innes H, Marshall E (2007) Outpatient therapy for febrile neutropaenia. Curr Opin Oncol 19:294–298PubMed
36.
go back to reference Demshar R, Vanek R, Mazanec P (2011) Oncologic emergencies new decade, new perspectives. AACN Adv Crit Care 22(4):337–348CrossRefPubMed Demshar R, Vanek R, Mazanec P (2011) Oncologic emergencies new decade, new perspectives. AACN Adv Crit Care 22(4):337–348CrossRefPubMed
37.
go back to reference Blinman PL, Grimison P, Barton MB, Crossing S, Walpole ET, Wong N, Koczwara B (2012) The shortage of medical oncologists: the Australian medical oncology workforce study. Med J Aust 196(1):58–61CrossRefPubMed Blinman PL, Grimison P, Barton MB, Crossing S, Walpole ET, Wong N, Koczwara B (2012) The shortage of medical oncologists: the Australian medical oncology workforce study. Med J Aust 196(1):58–61CrossRefPubMed
38.
go back to reference Huws DW, Cashmore D, Newcombe RG, Roberts A, Vincent J, Elwyn G (2008) Impact of case management by advanced practice nurses in primary care on unplanned hospital admissions: a controlled intervention study. BMC Health Serv Res 8:115PubMedCentralCrossRefPubMed Huws DW, Cashmore D, Newcombe RG, Roberts A, Vincent J, Elwyn G (2008) Impact of case management by advanced practice nurses in primary care on unplanned hospital admissions: a controlled intervention study. BMC Health Serv Res 8:115PubMedCentralCrossRefPubMed
Metadata
Title
Unplanned oncology admissions within 14 days of non-surgical discharge: a retrospective study
Authors
Samantha Gibson
Ruth McConigley
Publication date
01-01-2016
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 1/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-2786-6

Other articles of this Issue 1/2016

Supportive Care in Cancer 1/2016 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine