Emergency department visits and hospital readmissions for pain management among palliative care patients with advanced cancer

Purpose of Project: To identify how many palliative care patients with advanced cancer were visiting the ED or were readmitted to the hospital for pain management, identify reasons pain and palliative care patients with advanced cancer were returning to the ED for pain management rather than the outpatient setting; identify interventions in the literature that address return visits to the ED; and make recommendations to the palliative care team as to which intervention should be tested to address this problem. Methodology: This Quality Improvement project used a retrospective review of charts to evaluate the number of ED visits and hospital readmissions for pain management among palliative care patients with advanced cancer; and a review of the literature to establish recommendations to decrease ED visits and hospital readmissions for pain management among palliative care patients with advanced cancer. The retrospective review of charts was conducted by the clinical data science department as part of the Institute of Evidence-Based Practice and Nursing Research, using an EPIC computer system. The de-identified data was provided to the PD for analysis, leading to recommendations for improvement of post-discharge communication. The recommendations were developed based on a review of the literature of previous interventions that have been successful in various patient populations. Results: There was a total of 335 ED encounters for pain management among palliative care patient with advanced cancer between July 1, 2019 and December 31, 2019. 52.5% of ED encounters results in hospital admissions, 37.5% were treated and released, 2.23% left AMA, 7.57% were placed on observation, and 0.3% were sent for a procedure. There was an average of 55.8 ED encounters per month. Recommendations to decreased ED visits and hospital readmissions for pain management among palliative care patients with advanced cancer included follow up phone calls, utilization of patient navigators, and symptom clinics. Implications for Practice: The estimated cost-savings to the health care system can range between $57,498 and $152,796 per month, and $689,796 and $1,833,552 per year. This overall savings can support the creation of a dedicated position within the outpatient pain and palliative care clinic for the implementation of the proposed interventions. Additionally, the cost savings will be far greater if there is a continued decrease in ED visits not just within the pain and palliative care patient population, but across the healthcare system.DNPIncludes bibliographical reference