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Supportive Care in Cancer
Published in: Supportive Care in Cancer 8/2017

01-08-2017 | Original Article

Identification of appropriate and potentially avoidable emergency department referrals in a tertiary cancer care center

Authors: Claire Duflos, Sami Antoun, Philippe Loirat, Mario DiPalma, Etienne Minvielle

Published in: Supportive Care in Cancer | Issue 8/2017

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Abstract

Purpose

Referrals to the Emergency Department can be distressing to patients with advanced cancer and may be a non-optimizing health care service. We aimed to describe the appropriateness and potential avoidability of Emergency Department referrals in a tertiary cancer care center where only physician referrals are allowed.

Methods

We prospectively reviewed the electronic medical charts of patients consecutively checked into the Emergency Department in August 2015. The appropriateness of referrals was assessed using a nationally validated classification (Classification Clinique des Malades aux Urgences) and local criteria. Potentially avoidable referrals were assessed using international classifications (Institute for Healthcare Improvement State Action on Avoidable Rehospitalizations diagnostic tool according to Kosecoff’s criteria) and local criteria.

Results

We included 500 referrals related to 423 patients. The mean age was 59 years, and 74% of cancers were progressive. The referrals were appropriate in 61% of cases. They were deemed potentially avoidable “with a high likelihood” in 33.4% (CI95% [29.3–37.5]) of cases, potentially avoidable “with a moderate likelihood” in 14.4% (CI95% [11.3–17.5]) of cases, and “non-avoidable” in 52% (CI95% [47.6–56.4]) of cases. Opportunities to avoid referrals after an index stay involved this hospital stay or discharge process in 66 cases (28%), the follow-up period in 59 cases (25%), or both in 66 cases (28%).

Conclusions

Potentially avoidable ED referrals are common in patients with cancer. These potentially avoidable ED referrals underline the importance of several domains of care coordination.
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Metadata
Title
Identification of appropriate and potentially avoidable emergency department referrals in a tertiary cancer care center
Authors
Claire Duflos
Sami Antoun
Philippe Loirat
Mario DiPalma
Etienne Minvielle
Publication date
01-08-2017
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 8/2017
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-017-3611-1

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