Introduction. Neoplastic diseases are increasing in patients older than 65 years.The hospital Emergency Department often have considerable difficulties in identifying the most appropriate Department for the hospitalization of patients with known malignancy or suspected neoplastic disease and the physician with the elderly patient have difficulties to prescribe the appropriate diagnostic program. These problems often have as a consequence an increase of the times of hospitalization, sometimes in inappropriate departments, an increase of costs and sometimes an increased risk to the frail elderly with cancer.
Obiectives. The aim of the paper is to suggest a care pathway in which is provided for, both in the Emergency Department ED) and in the Geriatrics Department (GD) the use of ultrasound (US) as a preliminary diagnostic technique, performed early by medical experts in elderly patients with known malignancy and in all clinical situations in which the physician suspected neoplastic disease. In elderly patients there is the frequent coexistence of multiple pathologies associated with the known condition of "fragility," and it is essential to program a rapid care pathway, with possibly non-invasive methods, easy to implement in order to achieve the objective of appropriateness of admission and the diagnostic and therapeutic, improving safety and quality assistance.
Methods. The US has been the first instrumental diagnostic examination to be performed both in ED and in the GD in the first day of hospitalization, in all patients over the age of 65, suffering from cancer known or in which it was formulatedthe hypothesis of neoplastic disease.200 patients were included : -A) 100 patients over the age of 65, suffering from cancer primary or secondary note, already previously hospitalized in other departments (oncology, hematology, surgery, urology, gynecology, etc.) and joints ED for the symptoms that are not associated to known malignancy. -B) 100 patients whose ED doctor suspected neoplastic disease.In all patients was performed the US of the abdomen and pelvis, in ED and in GD
within 12 hours from hospitalization. The two groups of 100 patients each were compared with two other groups of 100 patients each, homogeneous for age , in which was not carried out earlier the US, neither in the ED nor in-patient Geriatrics Department.
Results. The US performed early has identified in the first group of 100 patients with primary or metastatic neoplasms (65 women, 35 men, 65 to 98 years old), three subgroups: 1 A) 30 patients with severe clinical conditions with malignancies
advanced stage, requiring only palliative therapy, analgesic, nutritional, ecc.
US performed in ED allowed to transferring patients in a short time in long term care, Hospice or Home with protected discharge, Home Care Integrated. 2A) 20 patients with neoplastic diseases requiring proper staging and suitable therapy . US performed in ED allowed to select the appropriate department for hospitalization and properly direct the next instrumental diagnostic procedure. 3A) 50 patients who, having already been
undergoing cancer therapy, were suffering from multiple non-oncological diseases, however often related to cancer or chemotherapy . US was performed in ED or in the GD helped to reduce hospitalization time for tumor monitoring and for the diagnostic program for the other diseases associated . In the second group of 100 patients in which the ED doctor had formulated the hypothesis of neoplastic disease, the US performed in the ED allowed to select the most appropriate department for hospitalization and allowed to prescribe the appropriate therapeutic and diagnostic program. These results, compared with two other groups of 100 patients each in which has not been
performed early the US , showed that the average hospital stay was for all patients in which has not been performed US, higher (4-16 days, mean 10) and that the transfers in the appropriate departments were carried out from 4 to 10 days later.
The project limits are the need for an adequate number of US equipments and an adeguate number of phusicians experts in ultrasound.
Conclusion. The results confirmed that the US performed early, in ED and in GD, allows to set the appropriate diagnostic and therapeutic procedure, reducing length of stay and costs and increasing patient safety for the elderly patients with neoplastic diseases.
Use of ultrasound in Graduate Medical and Continuing Education , Patient Safety
