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

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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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Acknowledgements

The authors thank Mr. Stanislas Esposito who entered the data.

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Authors and Affiliations

  1. EA MOS EHESP, Gustave Roussy, Villejuif, France

    Claire Duflos, Philippe Loirat & Etienne Minvielle

  2. DIM CHU Montpellier, Montpellier, France

    Claire Duflos

  3. Urgences Institut Gustave Roussy, Villejuif, France

    Sami Antoun & Mario DiPalma

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  1. Claire Duflos
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  2. Sami Antoun
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Correspondence to Claire Duflos.

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The authors have no conflicts of interest related to this research. They have full control of all primary data and agree to allow the journal to review their data if requested.

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Duflos, C., Antoun, S., Loirat, P. et al. Identification of appropriate and potentially avoidable emergency department referrals in a tertiary cancer care center. Support Care Cancer 25, 2377–2385 (2017). https://doi.org/10.1007/s00520-017-3611-1

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  • DOI: https://doi.org/10.1007/s00520-017-3611-1

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