Background: Observations units commonly serve as an intermediate stage between the emergency department and inpatient hospitalization where patients of appropriate acuity are managed, however many observation units exist serving diverse patient populations ranging from peripartum or post-op surgical. Patients in observation units typically have lower-acuity health concerns and have an average length of stay of 24 hours. Notably, these populations are often managed by hospitalist or emergency medicine providers.
Purpose: The purpose of this study was to explore the possibility of opportunistic cancer screening for patients admitted to observation units.
Description: Patients admitted to an observation unit of a large hospital who meet the screening age of the United States Preventive Services Task Force (USPSTF) guidelines for breast, cervical, colorectal, and lung cancer were approached to participate in a short survey about demographics, cancer screening history and barriers to healthcare access. Participants were also surveyed for their receptiveness to cancer screening during hospital admission. Survey data was then analyzed using simple statistical methods.A total of 16 participants were included in this study. Of the 7 participants eligible for breast cancer screening, only one was found to be not up-to-date with USPSTF screening guidelines. Of the 6 participants eligible for cervical cancer screening, only one was found to be not up-to-date. Of the 14 participants eligible for colon cancer screening, 6 were considered not up-to-date. All 4 participants eligible for lung cancer screening were found to be not up-to-date. All participants were currently under the care of a PCP. Subjects agreed that staying up to date with cancer screening was a priority with an average of 4.0 (1 = strongly disagree; 5 = strongly agree). Additionally, participants expressed agreement to cancer screening during hospitalization if available, with an average of 3.8 (1 = strongly disagree; 5 = strongly agree).
Conclusions: This study demonstrated that patients admitted to hospital observation units would be open to and benefit from hospital-based cancer screening. A significant number of participants were found to be not up-to-date for colon and lung cancer screening. Interestingly, all participants reported having a PCP, demonstrating that opportunistic screening outside of the primary care setting could bridge the gap in screening eligible populations. Opportunistic cancer screening and other preventive public health interventions such as smoking cessation and HIV/AIDs testing have been successfully implemented during ED wait times. Observation units could similarly serve as a ripe setting for opportunistic cancer screening. Furthermore, cancer screening can be done efficiently and noninvasively with a Fecal Immunochemical Test (FIT) for colorectal cancer or HPV self-swab which could be approved for cervical cancer screening in the near future. Alternatively, if these resources were not available, patient education and referral to community screening resources may provide significant public health benefit.