Characteristics and Outcomes of Patients with Cancer Pain Placed in an Emergency Department Observation Unit

SIMPLE SUMMARY: Pain is an important yet undertreated complication of cancer that has been shown to affect patients’ quality of life. For patients presenting in an acute care setting with cancer-related pain, there have traditionally been two routes to management: inpatient or outpatient. However, with the advent of observation units, there is now an opportunity for these patients to utilize hospital resources without an inpatient stay. To better understand the role of an observation unit in pain management, this study analyzed charts for patients who had their pain managed in an observation unit. Patient characteristics and outcomes were statistically analyzed and summarized. Predictors of admission or discharge from the observation unit were also derived from the analysis. Factors that predicted an inpatient hospitalization from the observation unit included patients’ pain scores and the need for consult service recommendations while in the observation unit. Indeed, this research showed that patients in an observation unit for pain management received appropriate consultations and admissions when necessary. However, most were discharged home safely and without a quick return to the acute care setting. ABSTRACT: Pain remains an undertreated complication of cancer, with poor pain control decreasing patients’ quality of life. Traditionally, patients presenting to an emergency department with pain have only had two dispositions available to them: hospitalization or discharge. A third emerging healthcare environment, the emergency department observation unit (EDOU), affords patients access to a hospital’s resources without hospitalization. To define the role of an EDOU in the management of cancer pain, we conducted a retrospective study analyzing patients placed in an EDOU with uncontrolled cancer pain for one year. Patient characteristics were summarized using descriptive statistics and predictors of disposition from the EDOU and were identified with univariate and multivariate analyses. Most patients were discharged home, and discharged patients had low 72-hour revisit and 30-day mortality rates. Significant predictors of hospitalization were initial EDOU pain score (odds ratio (OR) = 1.12; 95% CI 1.06–1.19; p < 0.001) and supportive care (OR = 2.04; 95% CI 1.37–3.04; p < 0.001) or pain service (OR = 2.67; 95% CI 1.63–4.40; p < 0.001) consultations. We concluded that an EDOU appears to be the appropriate venue to care for a subsegment of patients presenting to an emergency department with cancer pain, with patients receiving safe care as well as appropriate consultation and admission when indicated.