WHAT WAS LEARNED

The study showed that younger cancer patients and those with no comorbidities had higher rates of observation status. Patients with cancer with no prior hospitalizations and those with lower stage cancer at diagnosis also had higher rates of observation status visits per 1000 inpatient admissions.

The estimated observation rate per 1000 inpatient admissions was higher for patients younger than 75 years compared with those aged 75 years and older. The same was true for those with a Charlson comorbidity index of 0 compared with a Charlson comorbidity index of 1 or 2 and higher. The type of cancer appeared to make a difference. The study showed that patients with breast cancer and prostate cancer had higher adjusted and unadjusted observation rates per 1000 inpatient admissions compared with those with colon cancer and lung cancer.

The authors noted that observation status may be a viable and possibly a better alternative than inpatient admission for patients presenting to the ED with specific conditions such as chest pain, new-onset atrial fibrillation, chronic obstructive pulmonary disease (COPD) exacerbation, and transient ischemic attack.

IMPLICATIONS FOR NURSES 

“In our study, we found that observation status was used less for people with cancer than without cancer. This suggests a potential opportunity to develop standards and treatment protocols to address specific clinical conditions to increase the systematic use of observation status for patients with cancer. Moving forward, standards to help manage cancer patients can help to optimize resource utilization in the emergency department,” Dr Lipitz-Snyderman told Oncology Nurse Advisor.

The researchers hope that risk stratification paradigms can be adopted for febrile neutropenia and other conditions such as steroid-related hyperglycemia. The National Cancer Institute (NCI) has identified the management of oncologic emergencies as an important knowledge gap and in 2015 set up the creation of the Comprehensive Oncologic Emergencies Research Network (CONCERN).

Oncology patients who present to ED potentially could benefit if guidelines and strategies were developed that specifically address clinical conditions such as nausea, vomiting, diarrhea, pain, constipation, cellulitis, and hypercalcemia. “Observation status allows for additional time to be certain that a patient’s clinical status is stabilized and that the correct diagnosis has been made. This provides the treating staff, patient, and caregiver a greater feeling of security upon discharge,” said Dr Lipitz-Snyderman.

Reference

Lipitz-Snyderman A, Klotz A, Gennarelli RL, et al. A population-based assessment of emergency department observation status for older adults with cancer. J Natl Compr Canc Netw. 2017;15:1234-1239.