title: An ED pilot intervention to facilitate outpatient acute care for cancer patients.
abstract: BACKGROUND
  Unplanned hospitalizations are common in patients with cancer, and most hospitalizations originate in the emergency department (ED).
  
  
  METHODS
  We implemented an ED-based pilot intervention designed to reduce hospitalizations among patients with solid tumors. The intervention, piloted at a single academic medical center, involved a medical oncologist embedded in the ED during evening hours. We used a quasiexperimental preimplementation/postimplementation study design to evaluate the proportion of ED visits that resulted in inpatient hospital admission, before and after pilot implementation. General estimating equations were used to evaluate the association between the intervention and hospital admission.
  
  
  RESULTS
  There were 390 ED visits by eligible cancer patients in the preintervention period and 418 visits in the intervention period. During the intervention period, 158 (38%) of 418 ED visits were identified by the embedded oncologist during the evening intervention shift. The proportion of ED visits leading to hospitalization was 70% vs 69% in the preintervention and intervention periods (odds ratio, 0.93 [95% confidence interval, 0.69-1.24]; P= .62). There were no differences between periods in ED length of stay or subsequent use of acute care. Among patients with initial ED presentation during the operating hours of the intervention, the proportion of ED visits leading to hospitalization was 77% vs 67% in the preintervention and intervention periods (odds ratio, 0.62 [0.36-1.08]; P= .08).
  
  
  CONCLUSIONS
  Embedding an oncologist in the ED of an academic medical center did not significantly reduce hospital admissions. Novel approaches are needed to strengthen outpatient acute care for patients with cancer.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215; Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115. Electronic address: gabriel_brooks@dfci.harvard.edu.
authors.forename: Gabriel A
authors.initials: GA
authors.lastname: Brooks
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215; Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
authors.forename: Eddy J
authors.initials: EJ
authors.lastname: Chen
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215; Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Murakami
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215; Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
authors.forename: Marios
authors.initials: M
authors.lastname: Giannakis
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baugh
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215; Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
authors.forename: Deb
authors.initials: D
authors.lastname: Schrag
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods / Q000458:organization & administration*; D065187:Controlled Before-After Studies; D003422:Critical Care / Q000379:methods / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010865:Pilot Projects; D055815:Young Adult