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Association of emergency department admission and early inpatient palliative care consultation with hospital mortality in a comprehensive cancer center

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Abstract

Purpose

Consultation to palliative care (PC) services in hospitalized patients is frequently late after admission to a hospital. The purpose of this study is to examine the association of in-hospital mortality and timing of palliative care consultation in cancer patients admitted through the emergency department (ED) of MD Anderson Cancer Center.

Methods

Institutional databases were queried for unique medical admissions over a period of 1 year. Primary cancer type, ED versus direct admission, length of stay (LOS), presenting symptoms, and in-hospital mortality were reviewed; patient data were analyzed, and risk factors for in-hospital mortality were identified. The association of early palliative care consultation (within 3 days of admission) with these outcomes was studied. Descriptive statistics and multivariate logistic regression model were used.

Results

Equal numbers of patients were admitted directly versus through the ED (7598 and 7538 respectively). However, of all patients who died in the hospital, 990 (88%) were admitted through the ED, compared with 137 admitted directly (P < 0.001). Patients who died in the hospital had longer median LOS compared with patients who were discharged alive (11 vs. 4 days, respectively, P < 0.001). Early palliative care consultation was associated with decreased mortality, compared with late consultation (P < 0.001). Chief complaints of respiratory problems, neurologic issues, or fatigue/weakness were significantly associated with in-hospital mortality.

Conclusion

We found an association between ED admission and hospital mortality. Decedent cancer patients had a prolonged LOS, and early palliative care consultation for terminally ill symptomatic patients may prevent in-hospital mortality and improve quality of cancer care.

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Acknowledgments

The authors acknowledge the scientific publication department at MD Anderson for editorial support.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Unit 1468, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA

    Imad El Majzoub, Aiham Qdaisat, Patrick S. Chaftari, Sai-Ching J. Yeung, Mazen Jizzini, Maria Teresa Cruz Carreras, Hussna Abunafeesa & Ahmed F. Elsayem

  2. Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    Imad El Majzoub & Rasha D. Sawaya

Authors
  1. Imad El Majzoub
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  2. Aiham Qdaisat
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  3. Patrick S. Chaftari
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  4. Sai-Ching J. Yeung
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  5. Rasha D. Sawaya
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  6. Mazen Jizzini
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  7. Maria Teresa Cruz Carreras
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  8. Hussna Abunafeesa
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  9. Ahmed F. Elsayem
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Contributions

Conception and design

Imad El Majzoub, Aiham Qdaisat, Patrick S. Chaftari, Sai-Ching J. Yeung, Rasha D Sawaya, Maria Teresa Cruz Carreras, Hussna Abunafeesa, and Ahmed F. Elsayem

Provision of study materials or patients

Imad El Majzoub, Ahmed F. Elsayem, and Sai-Ching J. Yeung

Collection and assembly of data

Imad El Majzoub, Aiham Qdaisat, Ahmed F. Elsayem, and Patrick S. Chaftari

Data analysis and interpretation

Imad El Majzoub, Aiham Qdaisat, Patrick S. Chaftari, Sai-Ching J. Yeung Rasha D Sawaya, Mazen Jizzini, Maria Teresa Cruz Carreras, Hussna Abunafeesa, and Ahmed F. Elsayem

Manuscript writing

Imad El Majzoub, Aiham Qdaisat, Hussna Abunafeesa, Patrick S. Chaftari, Sai-Ching J. Yeung Rasha D Sawaya Mazen Jizzini, Maria Teresa Cruz Carreras, and Ahmed F. Elsayem

Final approval of manuscript

All authors

Dr. Elsayem have full control of the primary data, which may be accessed by the journal if requested.

Corresponding author

Correspondence to Ahmed F. Elsayem.

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Conflict of interest

The authors declare that they have no conflicts of interest.

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El Majzoub, I., Qdaisat, A., Chaftari, P.S. et al. Association of emergency department admission and early inpatient palliative care consultation with hospital mortality in a comprehensive cancer center. Support Care Cancer 27, 2649–2655 (2019). https://doi.org/10.1007/s00520-018-4554-x

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  • DOI: https://doi.org/10.1007/s00520-018-4554-x

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