24-hour cancer clinic reduces ED visits, patient costs
PHOENIX —A 24-hour cancer clinic at Froedtert & the Medical College of Wisconsin resulted in a 26% reduction in ED utilization and high patient satisfaction, according to a presentation at the Association of Community Cancer Centers National Oncology Conference.
“We knew, as many of you may know as well, that our patient population was continuing to increase both in volume and in acuity,” Tina Curtis, DNP, MBA, RN, NEA-BC, executive director of cancer services at Froedtert & the Medical College of Wisconsin Cancer Center, said during her presentation. “We have been managing 4% to 5% growth year-over-year for at least the last 10 years, and we don’t see any signs of that slowing down. What we were starting to feel was that the patients were much sicker than we had seen in the past, and there were a lot of ongoing challenges to do whatever we could in the outpatient setting to avoid inpatient admissions and inpatient complexities of care.”
To help tackle symptom management and urgent needs, Curtis and colleagues established a 24-hour cancer clinic with the goal of reducing costs by having the patients see someone familiar with oncology who would order only the needed tests.
Curtis and colleagues conducted an audit to determine why oncology patients were utilizing the ED and if any of those visits could be better facilitated at an outpatient clinic.
“Every person I talked to had a story of a patient that had been sent to the ED and probably didn’t need to be there,” Curtis said.
Data showed 55% of oncology patients in the ED were admitted, but only 5% of these admissions were to the ICU. When Curtis and colleagues looked at individual patient examples, they felt some of the ED visits could have been avoided.
The clinic was set up to treat fever, dehydration, nausea, vomiting, rashes, painful urination, mild shortness of breath, pain (not chest pain), bleeding, diarrhea, fatigue/malaise, mouth sores/throat pain, and cold/flu-like symptoms.
The clinic was able to provide services including:
- supportive care;
- fluids, electrolytes and antibiotics;
- IV medications;
- urgent labs;
- resolution of home infusion pump concerns; and
- basic diagnostics, such as ECG, X-ray and CT scan.
In the first 2 years of the program, the clinic took up the space of two inpatient rooms. It was staffed with one hematology/oncology advanced practice provider and two nurses, or a nurse and a technician.
In its first year, the 24-hour cancer clinic reduced ED utilization for oncology patients by 26%. The clinic also resulted in fewer admissions compared with the ED (current admission rate, 21% vs. 46%). However, about 9% of the admissions originating from the 24-hour clinic were provider-ordered, planned admissions.
When comparing diagnostic utilization, patients seen in the 24-hour clinic had fewer radiology orders (11% vs. 75%), 12-lead ECG orders (4% vs. 44%) and lab orders (71% vs. 87%) than those seen in the ED.
“What we found was that some of it was just standard practice in the ED and some of it was experience with oncology,” Curtis said. “We could find the labs, or find the scans more easily than they could find them in the ED. We could talk to providers who would say, ‘I’m OK if these labs are a few hours old. I don’t need to reorder it.’ Whereas in the ED, they weren’t as comfortable.”
Fewer orders resulted in patient savings. Among patients who were admitted, those who were seen in the clinic had a median patient charge for diagnostic testing that was $2,521 less than for those seen in the ED. Among those who were discharged, diagnostic testing charges were $1,162 lower among those seen in the clinic.
Both patient and staff satisfaction with the clinic’s services were in the 90th percentile. Although there currently are no formal data, Curtis said the providers have also expressed satisfaction with the clinic.
“After about 2 years, we felt confident that by taking some nonemergent cancer patients and providing them with a space that’s there for them 24 hours a day, it’s decreased our resource and ED utilization,” Curtis said. “We’re able to lower the number of hospitalizations we had. We maintained a high patient satisfaction and we were actually able to lower the cost of care for our patients. Our challenge now is to figure out where we go after 2 years.” – by Cassie Homer
Curtis T. Right place, right provider, right time: Implementing our 24-hour cancer clinic. Presented at: ACCC National Oncology Conference; Oct. 17-19, 2018; Phoenix.
Disclosure: Curtis reports no relevant financial disclosures.