Patients with solid organ malignancies often require unplanned admission via the emergency department (ED), despite efforts to minimise unintended complications of their disease and treatment. We analysed patterns of unplanned admissions via ED over a 6 month period at our tertiary level facility in order to review practice and inform service provision.
We performed a retrospective analysis of all unplanned medical and radiation oncology admissions via ED over a six month period at our institution. Clinical and demographic details, including time and reason for admission, tumour type, oncological treatment and involvement with palliative care services, were collected from the Emergency Department Information System (EDIS) and electronic medical records. Descriptive and comparative statistics were performed.
Between May and November 2015, 445 patients were admitted to Cancer Care Services via the ED. Of these, 260 had solid organ malignancies and were admitted under oncology. Most admissions (66%) occurred after hours. Breast cancer was the most represented solid tumour (14.6%), followed by colorectal (13.1%), head and neck (12.7%), and lung (12.7%). The most common reason for admission was non-neutropenic fevers (19%), followed by uncontrolled pain (17.3%), nausea/vomiting (9.6%) and neutropenic fevers (7.3%). Most patients (86%) were undergoing active treatment, with 68.5% receiving cytotoxic chemotherapy, immunotherapy or targeted therapy. Mean time from last treatment till presentation was 13 days. Approximately one-quarter (26.5%) of admissions were treatment related; the majority however, were driven by disease-related symptoms/complications (59%). Most patients (74%) were being managed with non-curative intent; of these, 67.5% were known to palliative care.
Our review has demonstrated unplanned admission data similar to published literature, with some exceptions that will be explored in subsequent analysis. Most ED admissions occurred after hours and although most patients were receiving active treatment, majority of presentations were not directly related to this.