Intervention Reduces Emergency Department Visits, Improves Patient Care

Jennifer A. Wenzel, PhD, RN, CCM, FAAN

Brian Hunis

A telephone triage service combined with patient education has helped to reduce cancer-related emergency department visits by 60% over 4 months, where it was piloted at a Florida health system, and it’s an approach researchers say can be easily replicated by other practices.

Results of the study were released in advance of the American Society of Clinical Oncology’s (ASCO) 2016 Quality Care Symposium to be held February 26-27 in Phoenix.

“The overuse of emergency rooms is driving up health care costs and can hurt the quality of patient care in many ways,” said Gregory Masters, ASCO spokesperson and chair of the Quality Care Symposium News Planning Team, in a statement. “This study shows that putting simple measures in place can significantly decrease ER visits, helping patients to get the care they need faster.”

A review by the study authors showed that 48 percent of emergency department visits occurred during office hours of the five public hospitals of the Memorial Healthcare System in south Florida. Patients with breast cancer, hematologic malignancies, and gastrointestinal malignancies were identified as the main users of emergency services. The most common reasons for visits to emergency departments were pain, diarrhea, nausea, and fever.

This triage/patient education intervention trialed at Memorial Healthcare is the first of its kind according to study authors. A multidisciplinary physician team worked to develop a protocol for telephone operators to assess patient symptoms and determine when a referral to the emergency department was needed. The team also hired a triage nurse for consultation. Finally, oncology practices reserved time in their daily schedules for walk-in patients.

The other half of the initiative focused on patient education. Patients were taught about chemotherapy side effects and how they can handle side effects at home. Each patient also received a “chemotherapy passport” with his or her oncologist’s name, off-hours contact information, chemotherapy regimen, date of last treatment, and potential side effects associated with treatment.

The initiative was developed after the team of physicians completed ASCO’s Quality Training Program, which was launched in 2014 to help oncology practices improve patient care.

Overall, the new system elicited a 60% reduction in the number of patients utilizing emergency department services, which met the predetermined goal of the project, according to study authors. In addition, calls to the patient access center increased, and all patients’ treatment, triage, and responsible team member information were logged.

Lead study author Brian Hunis said that the success of this initiative has made him believe that it can be applied to any type of cancer or oncology practice.

“By implementing this new system, our goal was to reduce unnecessary patient discomfort, interruptions in treatment and financial burden,” said Hunis, Medical Director of Quality initiatives and the Head and Neck Cancer Program at Memorial Cancer Institute in Hollywood, Florida.

“This triage system is applicable to all patients on active treatment, regardless of the type of therapy they are receiving. We believe that other oncology practices could easily mimic our model.”

Hunis B, Alencar AJ, Castrelion AB, et al. Making steps to decrease emergency room visits in patients with cancer: our experience after participating in the ASCO Quality Training Program. Presented at: ASCO Quality Care Symposium; February 26-27, 2016; Phoenix, AZ. Abstract 51.