Management of oncology-related emergencies at the emergency department: A long-term undertaking

Background: The emergency department at the Singapore General Hospital is an emergency department with an annual census of 140,000 and oncology-related attendances of about 4000 (2.8%). These patients are often admitted for further care. Palliative care in the emergency department for these patients...

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Published in:Hong Kong journal of emergency medicine 2023-11, Vol.30 (6), p.333-340
Main Authors: Chua, Wei Lin Tallie, Chan, Shi En Joanna, Lai, Gillianne, Yong, Looi Yee Tracy, Kanesvaran, Ravindran, Anantharaman, Venkataraman
Format: Article
Language:English
Subjects:
Clinical medicine
Decision making
Emergency medical care
Emergency medical services
emergency medicine
Emergency services
Evaluation
hospital
Hospitals
integrative oncology
medical oncology
Oncology
Oncology service
Oncology, Experimental
Palliative care
Palliative treatment
Quality control
Vital signs
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Summary:Background: The emergency department at the Singapore General Hospital is an emergency department with an annual census of 140,000 and oncology-related attendances of about 4000 (2.8%). These patients are often admitted for further care. Palliative care in the emergency department for these patients is often minimal. The aim of this study was to determine the state of current management of oncology-related emergencies at the Singapore General Hospital's emergency department, hence identifying specific areas for intervention. Methods: We carried out a retrospective data review of all Singapore General Hospital's emergency department patients who had either cancer-related diagnoses or were admitted to the Medical Oncology Department in October 2018. Simple statistical analysis was then performed using IBM SPSS version 21. Results: Of 308 identified patients, there was approximately equal distribution by sex. The women were generally younger than the men (61.33 +- 13.63 years vs 67.36 +- 12.02 years, p = 0.063, confidence interval −8.94 to −3.13). Seventy- two (23.4%) of the patients arrived at emergency department by ambulance. The mean emergency department length of stay was 4.25 h. About half of the patients had either lung, colorectal, or breast as their primary site of cancer. There was no correlation between clinical severity according to the National Early Warning Scores and triage complaint-type or emergency clinical diagnosis. More than 90% were admitted, with about 32.6% dying during their inpatient stay. High National Early Warning Scores were significantly associated with mortality. Conclusion: There is large potential for interventions to improve patient well-being in the pre-hospital setting and emergency department. Given the sizable number of patients with poor outcomes, palliative care is also of paramount importance.
ISSN:1024-9079
2309-5407
DOI:10.1177/1024907920953675