Cancer, Emergencies
Conditions
Brief summary
The goal of this Single center prospective cross-sectional study is to identify the facilitators and barriers among caregivers in the emergency department that influence disposition of patients with solid and hematology malignancies. The main question it aims to answer is to categorize the facilitators and barriers identified by three groups of emergency department (ED) staff. Participants will be asked for permission, afterwards a short interview will be held with the different ED caregivers (ED nurse, attending physician and supervising physician).
Detailed description
The goal of this to identify the facilitators and barriers among caregivers in the emergency department (ED) that influence disposition of patients with solid and hematology malignancies. Participants will be asked for permission, afterwards a short interview will be held with the different caregivers (ED nurse, attending physician and supervising physician) in the ED. The interviews will be held in the order of the ED care pathway, meaning ED nurse first, treating physician second and supervising physician at last. The interviews will be conducted for every patient with each of the caregivers. Each interview will be conducted after the caregiver has made the first examination of the patient. The interview focuses on several parts of the emergency care process: The first part is regarding the actions that are executed during an ED visit. We will establish which actions are executed and why. The second part is regarding the suspected outcome for the patient. The third part will be about any potential improvements to the emergency care process for the patient.
Interventions
BEHAVIORALEmergency department caregivers interview
The interview focuses on several parts of the emergency care process: The first part is regarding the actions that are executed during an emergency department visit. We will establish which actions are executed and why. The second part is regarding the suspected outcome for the patient. The third part will be about any potential improvements to the emergency care process for the patient.
Sponsors
Erasmus Medical Center
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with solid or hematological malignancies and receiving system therapy or having received systemic therapy within the last 3 months. * Presented at or admitted from the emergency department for the oncology, hematology, neuro- or lung-oncology clinical unit. * Awake and conscious. * Possible to answer questions within the same shift / day after presentation in the ED.
Exclusion criteria
* \<18 years old. * Only received a surgical intervention as cancer treatment. * Not willing or able to give written informed consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clusters of facilitator and barriers identified by the supervising physician | Through study completion, an average of 6 months | (Sub)Clusters of facilitator and barriers identified by the supervising physician for the ED care of patients with cancer |
| Clusters of facilitator and barriers identified by the emergency department (ED) nurse | Through study completion, an average of 6 months | (Sub)Clusters of facilitator and barriers identified by the ED nurse for the ED care of patients with cancer |
| Clusters of facilitator and barriers identified by the treating physician | Through study completion, an average of 6 months | (Sub)Clusters of facilitator and barriers identified by the treating physician for the ED care of patients with cancer |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlation between ED-LOS and disposition | Through study completion, an average of 6 months | Correlation between ED-LOS and disposition |
| Years of medical experience | Through study completion, an average of 6 months | Number of years a medical staffmember is working in health care |
| Need for imaging | Through study completion, an average of 6 months | Was imaging ordered during ED visit and which kind |
| ED nurse agreement of disposition | Through study completion, an average of 6 months | Agreement between ED nurse expected disposition and the actual disposition |
| Attending physician agreement of disposition | Through study completion, an average of 6 months | Agreement between treating physician expected disposition and the actual disposition |
| Supervising physician agreement of disposition | Through study completion, an average of 6 months | Agreement between supervising physician expected disposition and the actual disposition |
| Time-to-disposition | Through study completion, an average of 6 months | The time between patient's arrival at the ED and the decision to disposition |
| Time-to-ward | Through study completion, an average of 6 months | The time between the decision to hospitalize and the arrival at the ward |
| Correlation between time-to-ward and the ED-LOS | Through study completion, an average of 6 months | Correlation between time-to-ward and the ED-LOS |
| Difference in categories | Through study completion, an average of 6 months | The difference in the percentages in categories between the different caregivers |
| ED nurse summary of actions | Through study completion, an average of 6 months | Summary of actions taken by ED nurse in the ED care for patients with cancer |
| Attending physician summary of actions | Through study completion, an average of 6 months | Summary of actions taken by attending physician in the ED care for patients with cancer |
| Supervising physician summary of actions | Through study completion, an average of 6 months | Summary of actions taken by supervising physician in the ED care for patients with cancer |
| ED crowding | Through study completion, an average of 6 months | Degree of crowding in the ED, consisting of number of patients in the ED and the ED crowding color code |
| Difference in clusters per group between day, evening and night | Through study completion, an average of 6 months | Difference in clusters per ED staff group between day, evening and night |
| Difference in clusters per group between weekdays and weekend | Through study completion, an average of 6 months | Difference in clusters per group between weekdays (Monday 08:00 till Friday 16:00) and weekend (Friday 16:01 till Monday 7:59) |
| Correlation between time-to-disposition and the ED-LOS | Through study completion, an average of 6 months | Correlation between time-to-disposition and the ED-LOS |
| Emergency department (ED) length of stay (LOS) | Through study completion, an average of 6 months | Emergency department length of stay |
| Disposition | Through study completion, an average of 6 months | Outcome after ED admission, being home or admission |
Other
| Measure | Time frame | Description |
|---|---|---|
| Patient characteristics | Through study completion, an average of 6 months | age, sex, type of cancer, type of treatment, main complaint, triage category, number of prior ED visits. |
Countries
Netherlands
Outcome results
None listed