Patients With Cancer May Overly Self-Refer to ED

Adults with cancer may not be using available clinician advice before self-referring to the emergency department, according to a study published online Sept. 14 in the American Journal of Managed Care.

Arthur S. Hong, M.D., M.P.H., from the University of Texas Southwestern Medical Center in Dallas, and colleagues used tumor registry records (university patients diagnosed 2008 to 2018 and safety-net patients diagnosed 2012 to 2018) and linked electronic health records and a regional health information exchange to analyze how well cancer patients self-triage based on diagnosis code-based severity of emergency department visits. The analysis included 39,498 adults with 38,944 emergency department visits to 67 hospitals.

The researchers found that patients self-referred for 85.5 percent of visits and bypassed a median of 13 closer emergency departments. Visits made at emergency departments that were closer to home were not significantly more clinically severe. Furthermore, visits were significantly less severe if the patient self-referred (adjusted odds ratio, 0.89) or they were on weekends (adjusted odds ratio, 0.93). Findings were similar when reanalyzing data within each individual health system.