Systematic Review of Interventions to Optimize Emergency Department Care of Patients with Cancer

Approximately 12% of patients with cancer annually visit the emergency department (ED) for disease- or treatment-related issues. These patients often face delays in care, including prolonged wait times and extended length of stay (LOS), contributing to ED crowding, delayed treatment, and increased mortality. Numerous studies have investigated interventions to reduce LOS and prevent ED visits for patients with cancer. However, a systematic overview of these interventions is currently lacking. In this review we aimed to present interventions that optimize input, throughput and output in ED care by reducing ED LOS or ED visits for patients with cancer.

We searched five electronic library databases: Medline ALL via Ovid; Embase.com; Web of Science Core Collection; the Cochrane Central Register of Controlled Trials via Wiley; and Google Scholar. Inclusion criteria for this review were as follows: 1) research on (a subset of) patients with cancer; 2) conducted in or in collaboration with the ED; 3) the introduction of an intervention aimed at optimizing ED input, throughput, and output; and 4) performance of the intervention was measured using outcomes, such as ED LOS, number of ED visits or hospitalizations, use of acute-care services, or time to antibiotics.

The literature search yielded 11,357 articles. After removing duplicates, 7,315 unique articles remained for screening. Of these, 109 were selected for detailed abstract review. Following this second screening, 35 articles underwent full-text analysis, and 16 articles met all inclusion criteria. These studies identified four categories of interventions: scoring systems (n=5); dedicated cancer urgent care facilities (n=5); protocolized care (n=3); and staffing optimization (n=3). Among scoring systems, use of the Edmonton Symptom Assessment Scale reduced ED visits (relative rate (RR) = 0.92) and hospitalizations (RR = 0.86), while the Clinical Index of Stable Febrile Neutropenia score showed higher specificity (98.3%) than the Multinational Association for Supportive Care in Cancer score (54.2%) for identifying low-risk febrile neutropenia.

We identified four categories of intervention that could potentially reduce ED visits and ED LOS, of which scoring systems showed the most potential. Rather than developing new tools, future efforts should prioritize the implementation, validation, and refinement of these existing strategies to optimize treatment of cancer patients in the emergency department.