A quality improvement initiative to reduce the reliance of patients on visits to the emergency department for treatment of side effects related to cancer treatment was reported to be highly effective, according to early findings from a new study. 1 The strategy, involving a telephone triage service coupled with patient education, decreased the use of emergency department services by 60% in the first 4 months after it was implemented in Florida. More results of the initiative were presented at the 2016 Quality Care Symposium held recently in Phoenix.1
According to investigators who presented the study, this is one of the first initiatives to offer a viable solution to overutilization of emergency departments by patients with cancer. In addition to improving the quality of patient care, the intervention has also resulted in substantial cost savings.
Triage System Explained
“By implementing this new system, our goal was to reduce unnecessary patient discomfort, interruptions in treatment, and financial burden,” said lead study author Brian Hunis, MD, Medical Director of Quality Initiatives and 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.”
Initiative Findings
The quality improvement project was implemented at the Memorial Healthcare System, which encompasses five public hospitals in South Florida. In the 5 months preceding the intervention, 48% of oncology patients’ visits to the emergency department had occurred during office hours. Patients with breast cancer, gastrointestinal cancers, and blood cancers were the most likely to use emergency department services, and the most common reasons for visits were treatment-related pain, diarrhea, nausea, and fever.
Impact of Phone Triage Service
- A telephone triage service, coupled with patient education, decreased the use of emergency department services by 60% in the first 4 months after it was implemented in Florida.
- A multidisciplinary team developed a protocol for telephone operators at the patient access center; center staff were trained to assess the severity of patient symptoms and recognize when an emergency department referral was appropriate; a triage nurse was hired for consultations, and participating practices added appointment times to provide care to walk-in patients.
- Patients were educated about chemotherapy side effects and how to handle issues that arise outside of office hours.
After this information was gathered and analyzed by study coauthor Vedner Guerrier, MBA, a multidisciplinary physician team developed a protocol for telephone operators to handle calls at the patient access center. The center staff was trained to assess the severity of patient symptoms and recognize when a referral to the emergency department was appropriate. A triage nurse also was hired to provide consultation services. In addition, participating oncology practices added appointment times to their daily schedules to provide care to walk-in patients.
The second part of the intervention involved educating patients about chemotherapy side effects and how to handle issues that arise outside of office hours. Each patient also received customized “chemotherapy passports,” which included his or her oncologist’s name and phone number (including after-hours contact information), chemotherapy regimen, date of last chemotherapy, potential side effects that may require hospital admission, and other resources to expedite emergency department triage.
The physicians developed this intervention after participating in ASCO’s Quality Training Program.2 Launched in 2014, the program provides interdisciplinary oncology teams with the tools they need to design, implement, and lead quality improvement activities in their practices. Upon completion of the 6-month comprehensive course, practices have the knowledge and skills to form a high-functioning improvement team and identify targets for improvement.
Kenneth D. Bishop, MD
A previous participant in ASCO’s Quality Training Program, Kenneth D. Bishop, MD, and colleagues from the Comprehensive Cancer Center of Rhode Island Hospital had a similar project that looked into reduction in emergency department utilization by patients with cancer. Dr. Hunis remarked that his project expanded on that same particular issue and also showed the economic impact of expanded access to outpatient clinics. ■
Disclosure: This study received funding from Memorial Healthcare System. Dr. Hunis owns stock in Celgene.
References
1. Hunis B, Alencar AJ, Castrellon AB, et al: Making steps to decrease emergency room visits in patients with cancer: Our experience after participating in the ASCO Quality Training Program. 2016 ASCO Quality Care Symposium. Presented February 26, 2016.
2. ASCO Quality Training Program Cultivates Quality, Oncology Leaders. February 22, 2016. Available at quality.asco.org/ascos-quality-training-program-cultivates-quality-oncology-leaders. Accessed March 14, 2016.
