ABSTRACT
Background/aims: At the Odette Cancer Centre in Toronto, Canada, almost 1 in 5 ambulatory palliative oncology patients presents to our local Emergency Department (ED) every month. Of these visits, approximately 50% are potentially avoidable as they result in a direct discharge home, or in an acute care admission of < 48 hours. For a palliative cancer patient, ED visits are frustrating, costly and are considered an indicator of poor-quality end-of-life care. To improve end-of-life care for this vulnerable population, reducing ED visits is imperative. Methods: We conducted an interrupted time series following the Model for Improvement with an aim to reduce the monthly ED visit rate for the patients of our oncology palliative care clinic by 20% over 1 year. A patient-informed root cause analysis was performed to guide the implementation of a bundle of three change concepts: (1) improving patients' after-hours access to hospital and home care (2) increasing video virtual visits;and (3) enabling early identification of caregiver burnout. Results: Monthly ED visit rates declined by 24% (p < 0.001) with evidence of sustained improvement. The percentage of ED visits that resulted in a hospital admission of < 48 hours remained unchanged. Fidelity was attained by the interventions associated with the first change concept. Conclusions: Improving patients' after-hours access to hospital and home care was associated with a clinically and statistically significant reduction in ED visits. This is the first study in the palliative oncology population to implement patient-informed interventions to reduce ED use. The study occurred during the COVID-19 pandemic which constitutes a significant confounding factor. Continued evaluation post-pandemic will serve to better understand ongoing trends in ED use.