Multidisciplinary clinician perspectives on avoidable emergency department use by patients during cancer treatment

The literature reports patient perspectives on emergency department (ED) use during cancer treatment. Despite provider and policy interest in reducing ED visits for these adult patients, there are no reports of clinician perspectives on ED care.

We conducted a qualitative study of semi-structured clinician interviews from 2018 to 2022. We interviewed nine ED and 12 safety-net oncology clinicians from the University of Texas Southwestern and its academically affiliated but clinically distinct safety-net-Parkland Health. We investigated perspectives on acute care needs and ED overuse, analyzed with the constant comparative method.

ED physicians had varying definitions of ED overuse but did not consider visits for pain, nausea/vomiting to qualify. Instead, there was concern for ED visits by patients near the end of life and who were unlikely to meaningfully benefit from hospital care. ED physicians exclusively relied on the oncology consult team for advice (staffed in part by oncology physician trainees), were unsure how to reach outpatient oncologists, and were unaware of an oncology urgent care clinic at their health system. Oncology physician trainees reported no formal training on triaging acute complaints, and variable familiarity with oncology urgent care. Oncology clinicians also did not view patients as overusing the ED, even for conditions due to chemotherapy effects.

We captured under-recognized facets of acute care delivery, especially limited contact between two important teams-emergency medicine and oncology. Contrary to policy perspectives, ED and oncology clinicians did not consider visits for chemotherapy complications to represent ED overuse.