A solution to reducing avoidable emergency department visits: Implementation of an outpatient oncology acute care clinic.

Authors

null

Sadaf Charania

UT Southwestern Simmons Comprehensive Cancer Center, Dallas, TX

Sadaf Charania , Judy Devlin , Edie Brucker , Shayna Simon , Christine Hong , Kavitha Nair , Angela F. Bazzell , John W. Sweetenham

Organizations

UT Southwestern Simmons Comprehensive Cancer Center, Dallas, TX, UT Southwestern Medical Center, Dallas, TX, UT Southwestern/Simmons Cancer Center-Dallas, Dallas, TX, The University of Texas Southwestern Medical Center, Dallas, TX, 6000 Harry Hines Blvd, Suite ND2.300, Dallas, TX, University of Texas Southwestern Medical Center, Dallas, TX

Research Funding

No funding received
None

Background: Emergency Department (ED) utilization by oncology patients accounts for more than 4.5 million visits in the United States annually, leading to hospitalization four times the rate of the general population.1,2 Many ED visits are the result of symptoms related to cancer or cancer treatment that can be managed on an outpatient basis. Unnecessary admissions lead to possible delays in cancer treatment and increased burden on healthcare resources.3 Simmons Acute Care (SAC), an advanced practice provider (APP)-led clinic, was established in August 2020 to provide an alternative model of oncology care to address these issues. Methods: A multidisciplinary team of key stakeholders was formed to develop an action plan. Institutional data was reviewed to identify the timing and volume of ED visits by oncology patients. Clinic hours were set Monday through Friday, 7:00am – 7:00pm, and referrals were made from primary oncology providers. Evidence-based clinical pathways were developed to standardize patient management, and a data collection plan was implemented to measure outcomes. Internal communications to patients and presentations at staff and faculty meetings occurred to inform patients and clinical staff/providers. Results: From August to December 2020, 165 patient visits were completed in SAC, 141 patients discharged home, 14 patients directly admitted to the hospital, and 10 patients transferred to the ED for a higher level of care. Based on data from 2020, the average cost of an ED visit for an oncology patient was $5,500 and increased to $28,500 if the patient is admitted. Patients with hematologic and gastrointestinal malignancies represented approximately 30% of all visits. Gastrointestinal symptoms were the most frequent presenting chief complaint. Conclusions: Supporting oncology patients in the ambulatory setting provided a reduction in admissions and unnecessary ED visits, leading to cost savings/avoidance to the patient and health system. Based on internal cost analyses, there are potential savings of over $2 million to the organization during this 5-month period. Additional studies are underway to assess patient satisfaction, as well as the economic impact for patients. 1. Rui PKK. National Hospital Ambulatory Medical Care Survey: 2015 emergency department summary tables. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf 2. Hong AS, Froehlich T, Clayton Hobbs S, Lee SJC, Halm EA. Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits. J Oncol Pract. 2019;15(6):e501-e509. doi:10.1200/JOP.18.00743 3. Roy M, Halbert B, Devlin S, Chiu D, Graue R, Zerillo JA. From metrics to practice: identifying preventable emergency department visits for patients with cancer. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. Published online November 7, 2020. doi:10.1007/s00520-020-05874-3

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Care Delivery and Regulatory Policy

Track

Care Delivery and Quality Care

Sub Track

Care Delivery

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr e13517)

DOI

10.1200/JCO.2021.39.15_suppl.e13517

Abstract #

e13517

Abstract Disclosures

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