On 2017 May 25, Cicely Saunders Institute Journal Club commented:

This paper was discussed on 12 May 2017 by the MSc students in Palliative Care at the KCL Cicely Saunders Institute.

The study, that we read with great interest, is a retrospective cohort study examining the association between palliative homecare services and the number of emergency department visits (in regards to both high and low acuity). Previous studies have shown that palliative care homecare services help reduce patients’ consecutive visits to emergency department. Therefore, in this study the authors tested the hypothesis that life-threatening visits could be reduced with the induction of palliative homecare services and education in treating high acuity symptoms at home.

The study used data from the Ontario Cancer Registry, including a large number of patients (54,743). The study showed that palliative homecare services could reduce the emergency department visit rate in both high and low-acuity groups, which could be considered a benefit of palliative homecare services. However, more information on the definition and the way of addressing palliative homecare services would allow better understanding of the generalizability of this finding. The authors used the Canadian Triage and Acuity Scale national guidelines as the classification, but we would have liked more information on the triage system and the allocation of patients according to their symptoms. For example, pain throat, malaise and fatigue are subjective symptoms which are less commonly classified as emergency or resuscitation-required, but in the study these were allocated in both acuity levels (high and low). We considered that this classification might affect the result significantly, therefore we would have appreciated further explanations.

Ka Meng Ao, Ming Yuang Huang, Pamela Turrillas, Myongjin Agnes Cho

On 2017 May 25, Cicely Saunders Institute Journal Club commented:

This paper was discussed on 12 May 2017 by the MSc students in Palliative Care at the KCL Cicely Saunders Institute.

The study, that we read with great interest, is a retrospective cohort study examining the association between palliative homecare services and the number of emergency department visits (in regards to both high and low acuity). Previous studies have shown that palliative care homecare services help reduce patients’ consecutive visits to emergency department. Therefore, in this study the authors tested the hypothesis that life-threatening visits could be reduced with the induction of palliative homecare services and education in treating high acuity symptoms at home.

The study used data from the Ontario Cancer Registry, including a large number of patients (54,743). The study showed that palliative homecare services could reduce the emergency department visit rate in both high and low-acuity groups, which could be considered a benefit of palliative homecare services. However, more information on the definition and the way of addressing palliative homecare services would allow better understanding of the generalizability of this finding. The authors used the Canadian Triage and Acuity Scale national guidelines as the classification, but we would have liked more information on the triage system and the allocation of patients according to their symptoms. For example, pain throat, malaise and fatigue are subjective symptoms which are less commonly classified as emergency or resuscitation-required, but in the study these were allocated in both acuity levels (high and low). We considered that this classification might affect the result significantly, therefore we would have appreciated further explanations.

Ka Meng Ao, Ming Yuang Huang, Pamela Turrillas, Myongjin Agnes Cho