Potential Improvements in Emergency Department Care for Cancer Patients According to Clinical Staff (OVERSEE-II)

Identification of Potential Improvements in the Acute Care Pathway for Cancer Patients in the Emergency Department (OVERSEE - II Trial)

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).

Study Overview

• Status: Recruiting
• Conditions: Emergencies; Cancer
• Intervention / Treatment: Behavioral: Emergency department caregivers interview

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.

• Study Type: Observational
• Enrollment (Estimated): 75

Contacts and Locations

• Study Contact: Name: Jason den Duijn; Phone Number: +31107040704; Email: j.denduijn@erasmusmc.nl

Study Locations

• Netherlands
  • Zuid-Holland
    • Rotterdam, Zuid-Holland, Netherlands, 3015GD
      • Recruiting
      • Erasmus MC
      • Contact: Jason den Duijn; Phone Number: +31107040704; Email: j.denduijn@erasmusmc.nl

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

In the emergency department (ED) of Erasmus medical center (MC) yearly around 1600 patients with cancer are presented to the ED. Based on the study design we will conduct interviews with 75 to 100 patients with solid and hematologic malignancies, who are receiving systemic therapy or have received systemic therapy within the last 3 months and are admitted to the ED department of the Erasmus MC for the oncology, hematology, lung- and neuro-oncology medical unit. If present, the interview will also be held with the family caregiver.

Description

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.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Cancer patients; All adult patients with solid or hematological malignancies and receiving systemic therapy or having received systemic therapy within the last 3 months that are admitted to the emergency department of the Erasmus medical center for the oncology, hematological, lung- and neuro-oncology medical unit are eligible for inclusion.

Behavioral: Emergency 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clusters of facilitator and barriers identified by the emergency department (ED) nurse	(Sub)Clusters of facilitator and barriers identified by the ED nurse for the ED care of patients with cancer	Through study completion, an average of 6 months
Clusters of facilitator and barriers identified by the treating physician	(Sub)Clusters of facilitator and barriers identified by the treating physician for the ED care of patients with cancer	Through study completion, an average of 6 months
Clusters of facilitator and barriers identified by the supervising physician	(Sub)Clusters of facilitator and barriers identified by the supervising physician for the ED care of patients with cancer	Through study completion, an average of 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Emergency department (ED) length of stay (LOS)	Emergency department length of stay	Through study completion, an average of 6 months
Disposition	Outcome after ED admission, being home or admission	Through study completion, an average of 6 months
Correlation between ED-LOS and disposition	Correlation between ED-LOS and disposition	Through study completion, an average of 6 months
ED nurse agreement of disposition	Agreement between ED nurse expected disposition and the actual disposition	Through study completion, an average of 6 months
Attending physician agreement of disposition	Agreement between treating physician expected disposition and the actual disposition	Through study completion, an average of 6 months
Supervising physician agreement of disposition	Agreement between supervising physician expected disposition and the actual disposition	Through study completion, an average of 6 months
Time-to-disposition	The time between patient's arrival at the ED and the decision to disposition	Through study completion, an average of 6 months
Time-to-ward	The time between the decision to hospitalize and the arrival at the ward	Through study completion, an average of 6 months
Correlation between time-to-disposition and the ED-LOS	Correlation between time-to-disposition and the ED-LOS	Through study completion, an average of 6 months
Correlation between time-to-ward and the ED-LOS	Correlation between time-to-ward and the ED-LOS	Through study completion, an average of 6 months
Difference in categories	The difference in the percentages in categories between the different caregivers	Through study completion, an average of 6 months
ED nurse summary of actions	Summary of actions taken by ED nurse in the ED care for patients with cancer	Through study completion, an average of 6 months
Attending physician summary of actions	Summary of actions taken by attending physician in the ED care for patients with cancer	Through study completion, an average of 6 months
Supervising physician summary of actions	Summary of actions taken by supervising physician in the ED care for patients with cancer	Through study completion, an average of 6 months
Years of medical experience	Number of years a medical staffmember is working in health care	Through study completion, an average of 6 months
Need for imaging	Was imaging ordered during ED visit and which kind	Through study completion, an average of 6 months
ED crowding	Degree of crowding in the ED, consisting of number of patients in the ED and the ED crowding color code	Through study completion, an average of 6 months
Difference in clusters per group between day, evening and night	Difference in clusters per ED staff group between day, evening and night	Through study completion, an average of 6 months
Difference in clusters per group between weekdays and weekend	Difference in clusters per group between weekdays (Monday 08:00 till Friday 16:00) and weekend (Friday 16:01 till Monday 7:59)	Through study completion, an average of 6 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient characteristics	age, sex, type of cancer, type of treatment, main complaint, triage category, number of prior ED visits.	Through study completion, an average of 6 months

Collaborators and Investigators

• Sponsor: Erasmus Medical Center
• Investigators: Principal Investigator: Jason den Duijn, Erasmus Medical Center

Study record dates

Study Major Dates

• Study Start (Actual): February 2, 2024
• Primary Completion (Estimated): May 1, 2024
• Study Completion (Estimated): July 1, 2024

Study Registration Dates

• First Submitted: July 18, 2023
• First Submitted That Met QC Criteria: July 26, 2023
• First Posted (Actual): August 3, 2023

Study Record Updates

• Last Update Posted (Actual): February 6, 2024
• Last Update Submitted That Met QC Criteria: February 2, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 10842

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No