Cancer patients admitted to an emergency or intensive care unit (ICU) have some critical requirement of basic care needs because of their unknown illness; time-point in the treatment plan and treatment-related deadliness resulting in organ damage, hemodynamic infection, or blood contamination. Over the past two decades, therapeutic advances have reshaped not just the medical approach but also the way hospital billing and coding tasks take place. An oncologist’s way to deal with patients with tumors, rethinking care settings, and considering more aggressive treatments is the need of the hour. Subsequently, patients with oncology problems frequently require extra time in an intensive care unit. As care and procedures for these patients keep on advancing, so should the knowledge base and capabilities of attendants from both the critical care and oncology facilities. Generally, these two medical specialties performed independently, but this led to in-house staffers having to handle both treatment service and administrative services like claims filing and also oncology medical billing and coding.
ICU for Oncology…
Since the beginning of intensive care as a formal health program in the late 1950s, we have seen rapid specialization in various kinds of ICUs to suit advancing life-supporting technologies and novel treatments.
One of the first reported critical care units was produced at the Johns Hopkins Hospital in the 1920s by Walter Dandy, which housed three beds for postoperative neurosurgical patients. Early ICUs were built for close checking by doctors and medical attendants who remained near the patient to respond to emergencies and provide care.
As ICU facilities advanced it concentrated on providing newly created supportive measures incorporating developments in mechanical ventilation, renal substitution treatment, continued hemodynamic observing, and extracorporeal support.
From the development of the ICU came the requirement for devoted oncology specialists. Experts during the time brought change to incorporate more patient-centered care units and the acknowledgment that high-power staffing delivered the best care to patients. With the objective of enhancing results, specialty ICUs started.
Cardiology and Neurology are two clinical specialties that truly have and had solitary ICUs. These days, other specific ICUs exist tailored to injury, consumption, organ transplant, and cardiothoracic medical procedures. In any case, would we say we are sure that patients have better results since they are dealt with in a specific ICU? Furthermore, in the event that we see an added advantage from ICUs organized by specialty, do we have to think about the development of specific ICUs for cancer patients, especially oncology?
Do patients in ICUs at cancer facilities centers perform better than those at general hospitals?
A recently published article in the Journal of Clinical Oncology, it is described how ICU organizational characteristics might affect clinical outcomes and resource utilization in patients with cancer. In ORCHESTRA (name of the research paper), the authors retrospectively reviewed 10,000 patients admitted to 75 ICUs. Of those, 55 were in general hospitals and 20 were in cancer centers.
The research writers found that the presence of clinical pharmacists in the ICU, the presence of ICU protocols, and daily meetings between oncologists and experts were associated with lower hospital mortality even after adjustment for hospital case volume. Protocols and daily meetings were also associated with more efficient resource utilization.
What is the Conclusion?
We as specialty oncology medical billers and coders support the need for cancer-specific guidelines for ICU admission and protocols for care that can be implemented in any ICU, general or cancer-specific.
If future studies show the added value of an oncological ICU, then further evaluation should be done, based on regional cancer prevalence and geographic resources, to most effectively transfer those cancer patients needing ICU level of care to a center with the infrastructure of a dedicated high intensity staffed oncological ICU.
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