title: Impact of observation status on hospital use for patients with cancer.
abstract: OBJECTIVE
  For patients with cancer, the impact of observation status on hospital and patient outcomes is not well understood. Our objective was to assess the impact that an observation unit had on hospital use for patients with cancer who presented to the Urgent Care Center at a comprehensive cancer center.
  
  
  METHODS
  We assessed the proportion of Urgent Care Center visits that resulted in an admission to the hospital at a comprehensive cancer center, before (July 9, 2012-December 31, 2012) versus after (July 9, 2013-December 31, 2013) implementation of the observation unit. We also assessed differences in length of stay and stratified the data by presenting complaint.
  
  
  RESULTS
  During each 6-month study interval, there were more than 10,000 patient visits to the Urgent Care Center, representing approximately 6,000 unique patients. Fewer visits resulted in an inpatient admission postimplementation (47%) compared with preimplementation (50%). The duration of hospital stay for admitted patients was higher in the post period (median 108 hours) than in the pre period (median 96 hours). Alternatively, the proportion of hospital admissions with a length of stay less than 24 hours was lower in the post period (pre: 7%; post: 5%). Lower admission rates postimplementation were observed for patients who presented with fluid and electrolyte disorders, nausea and vomiting, syncope, and chest pain.
  
  
  CONCLUSIONS
  We observed reductions in hospital use for patients with cancer related to an observation unit in a comprehensive cancer center. Adoption of this approach for this patient population has the potential to reduce hospital use, which is of interest to hospitals, payers, and patients.
authors: Memorial Sloan Kettering Cancer Center, New York NY snyderma@mskcc.org.
authors: Allison
authors: A
authors: Lipitz-Snyderman
authors: Memorial Sloan Kettering Cancer Center, New York NY.
authors: Adam
authors: A
authors: Klotz
authors: Memorial Sloan Kettering Cancer Center, New York NY.
authors: Coral L
authors: CL
authors: Atoria
authors: Memorial Sloan Kettering Cancer Center, New York NY.
authors: Steven
authors: S
authors: Martin
authors: Memorial Sloan Kettering Cancer Center, New York NY.
authors: Jeffrey
authors: J
authors: Groeger
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms
references: Prof Case Manag. 2009 May-Jun;14(3):143-50
references: 19474641
references: Acad Emerg Med. 2011 Sep;18(9):959-65
references: 21883638
references: Health Aff (Millwood). 2012 Jun;31(6):1251-9
references: 22665837
references: Health Aff (Millwood). 2012 Oct;31(10):2314-23
references: 23019185
references: N Engl J Med. 2013 Jul 25;369(4):302-5
references: 23883376
references: J Patient Saf. 2014 Sep;10(3):168-75
references: 24522222
references: J Clin Oncol. 2014 Feb 20;32(6):496-503
references: 24419123
references: JAMA Intern Med. 2013 Nov 25;173(21):1991-8
references: 23835927
references: Emerg Med J. 2003 Mar;20(2):138-42
references: 12642526
references: Med J Aust. 2003 Jun 2;178(11):559-63
references: 12765504
references: Med Care. 2014 Sep;52(9):796-800
references: 25054826