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Emergency department utilization by gynecologic cancer patients during the COVID-19 pandemic: unintended improvements in the selective use of emergency care?
OBJECTIVES: To evaluate the effects of the COVID-19 pandemic on emergency department (ED) utilization by gynecologic oncology patients in a large academic cancer center. METHODS: Institutional data were captured from the EMR for the first 4 months of the US COVID-19 pandemic (March-June 2020) and co...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8372507/ http://dx.doi.org/10.1016/S0090-8258(21)00921-5 |
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author | Byrne, Maureen Nasioudis, Dimitrios Gysler, Stefan Ko, Emily Haggerty, Ashley |
author_facet | Byrne, Maureen Nasioudis, Dimitrios Gysler, Stefan Ko, Emily Haggerty, Ashley |
author_sort | Byrne, Maureen |
collection | PubMed |
description | OBJECTIVES: To evaluate the effects of the COVID-19 pandemic on emergency department (ED) utilization by gynecologic oncology patients in a large academic cancer center. METHODS: Institutional data were captured from the EMR for the first 4 months of the US COVID-19 pandemic (March-June 2020) and compared to a historical control (March-June 2019). Data were collected from three major hospitals within an urban academic health system. Patients were identified as those with a gynecologic cancer diagnosis and active treatment (chemotherapy and/or radiation) within the prior 180 days of ED encounter, with an outpatient oncology visit within the last 90 days. Data including number and location of emergency department visits, admission outcomes, primary ICD-10 emergency department diagnosis, payer type, and patient demographics were collected. Descriptive statistics were performed. RESULTS: Gynecologic oncology patients were significantly less likely to present to the ED for care during the first 4 months of COVID-19 (n=91) when compared to a historical control (n=144), p<0.01. Patients presenting during COVID were more likely to be admitted (43/91 vs 47/144, p<0.01), and to be kept for observation (18/43 vs 8/47, p=0.01). Of patients who were admitted, those presenting during COVID were significantly more likely to require an ICU stay during admission (12/43 vs 5/47, p=0.04). Six patients admitted during COVID (14%) died during their admission, while 3 patients (6%) died in the control group. There were no differences with respect to race, payor type, diagnosis, length of stay, or need for procedures when comparing patients admitted during COVID versus the control group. Four patients were COVID 19 positive during admission, which contributed to 1 patient death. Utilization of the health system's outpatient oncology urgent care center remained unchanged during COVID-19 (n=19 vs. n=15, p=0.43). CONCLUSIONS: Fewer gynecologic cancer patients presented to the ED during the COVID-19 pandemic, and those presenting had increased rates of indicated and complex care requirements. The concurrent stability in the outpatient urgent care center volume highlights a potential role for more stringent patient triaging to improve healthcare utilization in this vulnerable population going forward. |
format | Online Article Text |
id | pubmed-8372507 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-83725072021-08-18 Emergency department utilization by gynecologic cancer patients during the COVID-19 pandemic: unintended improvements in the selective use of emergency care? Byrne, Maureen Nasioudis, Dimitrios Gysler, Stefan Ko, Emily Haggerty, Ashley Gynecol Oncol Featured Posters OBJECTIVES: To evaluate the effects of the COVID-19 pandemic on emergency department (ED) utilization by gynecologic oncology patients in a large academic cancer center. METHODS: Institutional data were captured from the EMR for the first 4 months of the US COVID-19 pandemic (March-June 2020) and compared to a historical control (March-June 2019). Data were collected from three major hospitals within an urban academic health system. Patients were identified as those with a gynecologic cancer diagnosis and active treatment (chemotherapy and/or radiation) within the prior 180 days of ED encounter, with an outpatient oncology visit within the last 90 days. Data including number and location of emergency department visits, admission outcomes, primary ICD-10 emergency department diagnosis, payer type, and patient demographics were collected. Descriptive statistics were performed. RESULTS: Gynecologic oncology patients were significantly less likely to present to the ED for care during the first 4 months of COVID-19 (n=91) when compared to a historical control (n=144), p<0.01. Patients presenting during COVID were more likely to be admitted (43/91 vs 47/144, p<0.01), and to be kept for observation (18/43 vs 8/47, p=0.01). Of patients who were admitted, those presenting during COVID were significantly more likely to require an ICU stay during admission (12/43 vs 5/47, p=0.04). Six patients admitted during COVID (14%) died during their admission, while 3 patients (6%) died in the control group. There were no differences with respect to race, payor type, diagnosis, length of stay, or need for procedures when comparing patients admitted during COVID versus the control group. Four patients were COVID 19 positive during admission, which contributed to 1 patient death. Utilization of the health system's outpatient oncology urgent care center remained unchanged during COVID-19 (n=19 vs. n=15, p=0.43). CONCLUSIONS: Fewer gynecologic cancer patients presented to the ED during the COVID-19 pandemic, and those presenting had increased rates of indicated and complex care requirements. The concurrent stability in the outpatient urgent care center volume highlights a potential role for more stringent patient triaging to improve healthcare utilization in this vulnerable population going forward. Elsevier Inc. 2021-08 2021-08-18 /pmc/articles/PMC8372507/ http://dx.doi.org/10.1016/S0090-8258(21)00921-5 Text en Copyright © 2021 Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Featured Posters Byrne, Maureen Nasioudis, Dimitrios Gysler, Stefan Ko, Emily Haggerty, Ashley Emergency department utilization by gynecologic cancer patients during the COVID-19 pandemic: unintended improvements in the selective use of emergency care? |
title | Emergency department utilization by gynecologic cancer patients during the COVID-19 pandemic: unintended improvements in the selective use of emergency care? |
title_full | Emergency department utilization by gynecologic cancer patients during the COVID-19 pandemic: unintended improvements in the selective use of emergency care? |
title_fullStr | Emergency department utilization by gynecologic cancer patients during the COVID-19 pandemic: unintended improvements in the selective use of emergency care? |
title_full_unstemmed | Emergency department utilization by gynecologic cancer patients during the COVID-19 pandemic: unintended improvements in the selective use of emergency care? |
title_short | Emergency department utilization by gynecologic cancer patients during the COVID-19 pandemic: unintended improvements in the selective use of emergency care? |
title_sort | emergency department utilization by gynecologic cancer patients during the covid-19 pandemic: unintended improvements in the selective use of emergency care? |
topic | Featured Posters |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8372507/ http://dx.doi.org/10.1016/S0090-8258(21)00921-5 |
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