Potential Improvements in Acute Cancer Care According to Clinical Staff in the Emergency Department Care

Study Overview
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Brief Summary
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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 what the agreement between the emergency department (ED) caregivers predicted outcome and the actual outcome is. 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
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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. The main question it aims to answer is: what is the agreement between the ED caregivers predicted outcome and the actual outcome. 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. It will be established, which actions are executed and why. The second part are regarding the suspected outcome for the patient. The third part will be about any potential improvements on de emergency care process for the patient.

Official Title
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Identification of Potential Improvements Among Cancer Patients and Clinical Staff in the Emergency Department Care Pathway: a Semi-qualitative Study (OVERSEE-II Trial)

Conditions
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Cancer, Emergencies

Intervention / Treatment
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* Behavioral: Emergency department caregivers interview


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Patients with solid and/or hematology malignancies and receiving system therapy Presented at the emergency department or admitted from the emergency department (ED) to the oncology, hematology or lung-oncology clinical unit Awake and conscious Possible to answer questions within 48 hours after presentation in the ED Exclusion Criteria: <18 years old Primarily received a surgical intervention as treatment Admitted to the ED for the surgical department Not willing or able to give written informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cancer patients<br>All adult patients with solid and hematologic malignancies and receiving systemic therapy admitted to the emergency department of the Erasmus Medical Center (MC) for the oncology, hematology, lung- and neuro-oncology medical unit. | Behavioral: Emergency department caregivers interview<br>* 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. The investigators will establish, which actions are executed and why. The second part are regarding the suspected outcome for the patient. The third part will be about any potential improvements on de emergency care process for the patient.<br>|

What is the study measuring?
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Primary 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 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 
| ED nurse identified categories of facilitator and barriers | Categories 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 | 
| Attending physician identified categories of facilitator and barriers | Categories of facilitator and barriers identified by the attending physician for the ED care of patients with cancer. | Through study completion, an average of 6 months | 
| Supervising physician identified categories of facilitator and barriers | Categories 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 | 
| 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 |