INTRODUCTION: Acute hospital care is the largest contributor to cancer care spending in the United States. Nearly 60% of cancer patients who present to an ED are admitted; up to 40% of these encounters are estimated to be preventable. Strategies to divert patients away from the ED are needed, especially in the setting of COVID-19, which has disrupted usual care provision and exposed already vulnerable cancer patients to even greater risk. At the James Cancer Hospital, we have implemented several interventions to mitigate unplanned ED usage: a robust after-hours nurse triage phone call program, extended hour infusion services capable of drug, fluid, and blood product administration, as well as the James Immediate Care Center (ICC), a 24/7 cancer-specific urgent care. Methods: To describe the impact of these tailored offerings on ED utilization, we reviewed encounter volumes for each service (after-hours nurse triage line, infusion services, ICC) and the rate of subsequent ED or direct inpatient admission after each service use between July 2020 and June 2021 at The James Cancer Hospital. Results: From July 2020 to June 2021, there were 12,111 patient calls to the after-hours nurse triage line. Care escalation was required for 7,135 (58.9%) of these calls; 3,129 (25.8%) only required nurse advice; the remainder were related to office appointment requests or cancelation. Of those requiring care escalation, the majority (3,557; 49.9%) were forwarded to an on-call provider; 28.4% (2,008) were directly referred to the ED, 24% (1,712) were referred to the ICC or for immediate in office evaluation, 2.2% (156) were advised to call 911. From this same time period, there were 83,586 infusion encounters. Of those, approximately 0.39% (330) were sent to the ED or directly admitted from the infusion center. In the ICC, 4,080 patients were seen between July 2020 and June 2021; only 2.7% (109) were transferred to the ED within 24 hours of ICC arrival, 26% (1,060) were directly admitted from the ICC to inpatient care. See Figure 1. Conclusion: A multipronged approach that includes after-hours nurse triage, infusion services, and cancer-specific urgent care is successful in preventing a significant volume of unplanned ED or other acute care utilization, even in times of high COVID-19 prevalence. Additional interventions to identify, target, and ultimately prevent those clinical presentations still requiring ED escalation are needed.
Total patient encounter volume & frequency of case referred for acute hospital care
Citation: Journal of the National Comprehensive Cancer Network 20, 3.5; 10.6004/jnccn.2021.7190
Total patient encounter volume & frequency of case referred for acute hospital care
Citation: Journal of the National Comprehensive Cancer Network 20, 3.5; 10.6004/jnccn.2021.7190
Total patient encounter volume & frequency of case referred for acute hospital care
Citation: Journal of the National Comprehensive Cancer Network 20, 3.5; 10.6004/jnccn.2021.7190
