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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 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).
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 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. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Emergency department caregivers interview | Behavioral | 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. |
| 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 |
| 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 |
| 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 |
Inclusion Criteria:
Exclusion Criteria:
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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.
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| Name | Affiliation | Role |
|---|---|---|
| Jason den Duijn | Erasmus Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Erasmus MC | Rotterdam | South Holland | 3015GD | Netherlands |
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| ID | Term |
|---|---|
| D009369 | Neoplasms |
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| 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 |
| 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 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 |
| 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 |