Administrators Need To Rethink Traditional Oncology Care Units

SAN DIEGO--Because of the new realities of health care, it istime to rethink the concept of traditional oncology units, JeanneT. Reardon, RN, said at the 8th Annual Cancer Care Symposium sponsoredby the Society for Ambulatory Care Professionals and Health TechnologyAssessment of the American Hospital Association.

"The oncology unit as the flagship of the oncology programis not going to be there anymore," said Ms. Reardon, theadministrative director of the cancer program at Methodist Hospitalsof Dallas. "You will require inpatient beds, but if that'sthe main focus of your program, it's time to rethink it."

In the future, she said, institutions will increasingly be reachingout to patients through multisite services, outpatient programs,and even mobile care. "Some hospitals will pack up theircancer care services, such as infusion therapy and laboratoryequipment, and travel through the community to workplaces, schools,and homes," she said.

Many institutions are struggling with the question of what todo with their oncology units. "Having spent a lot of time,energy, and resources to develop these specialty cancer unitsand programs, people are now looking at their patient volumesand saying that it may be time to close them," Ms. Reardonsaid. "That's an option, but it's not the only option youcan take."

Ms. Reardon's own institution is tackling this issue, broughtabout by the "compulsion" that gripped it and othermedical institutions in earlier years to construct new inpatientfacilities. "We built a big 350+ bed inpatient facility,"she said, "and guess what, folks, it's not working out allthat well."

Some hospitals have abandoned sub-specialty oncology units andmoved forward with a combination concept. These institutions tryto utilize medical oncol-ogy nurses by cross training them insurgical care so they can care for both medical and surgical oncologypatients, Ms. Reardon said.

Other hospitals have combined inpatient and outpatient facilitiesinto a single "day unit," utilizing the same nursingstaff for both inpatients and outpatients. "It's an interestingconcept because much of the outpatient care at this time is justas acute as what's on the inpatient side," she said. Manyoutpatients are going to be in the "day" unit for 16hours, requiring two nursing shifts.

Some cancer units now offer only ambulatory services, she said."These are freestanding entities that are literally runningtheir services 24-hours a day, 7 days a week. The only differencebetween these units and inpatient facilities is that patientsdon't sleep overnight in a bed. That may be the future of healthcare."

Clustered Bed Strategy

Another approach is the clustered bed strategy in which one medicalunit might have 10 beds each for oncology, renal, and cardiacpatients, each with its own subspecialty staff. "That's wonderfulif you can actually cluster your beds, and for many facilitiesthat is working well," Ms. Reardon said.

But often, hospitals are forced to scatter these patients in availablebeds throughout the hospital. "The problem comes in,"she said, "when you try to admit an acutely ill oncologypatient to the postpartum unit. Something is going to go wrong."

This problem can be remedied, however, if an institution has atraveling specialty team that can go where it is needed in thehospital. With such a team, she said, "you will probablybe able to function with a scattered bed approach." But,she added, the team must be willing to go wherever the patientsare and do whatever needs to be done.

"Other than home care, at this point," she said, "thereare not a lot of institutions that are talking about sending theirteams outside the facility."

Ms. Reardon also predicted that dwindling heath care dollars willnecessitate new oncology partnerships that might seem inconceivablein today's competitive climate.

"Not everybody in your community needs to have a 12-bed bonemarrow transplant unit. Not everybody needs to have the mobilemammography van. You are going to see more alliances, more sharedservices," she said. "The people you are competing withtoday will be your partners in the future."