Triage System Sharply Reduces ER Visits for Cancer Patients

A simple quality improvement initiative involving an improved patient access center (PAC) and patient education resulted in a 60% reduction in the use of emergency room (ER) visits in oncology patients, according to a new study. Results of the study will be presented at the 2016 American Society of Clinical Oncology (ASCO) Quality Care Symposium, held February 26–27 in Phoenix (abstract 51).

“By implementing this new system, our goal was to reduce unnecessary patient discomfort, interruptions in treatment, and financial burden,” said study lead author Brian Hunis, MD, of Memorial Cancer Institute in Hollywood, Florida, in a press release.

The study began with a review of Memorial Healthcare System’s-covering five area hospitals-oncology patients ER visits from January to May in 2015. The review found that 48% of the ER visits occurred during office hours, suggesting many visits could possibly be avoided. The main users of ER visits included those with breast, hematology, and gastrointestinal diagnoses. The researchers set a goal of reducing ER visits by 30%.

The intervention’s first step included an overhaul of a PAC, with new training for staff to be able to recognize when symptoms relayed over the phone merited an ER referral. A new triage nurse was also hired, to handle consultation services. Participating oncology practices added appointment times for walk-in patients to daily schedules, to provide an alternative to an ER visit.

In the second step, physicians educated patients on chemotherapy side effects, and how best to handle complications that arise outside of office hours. Patients also received a “chemotherapy passport”-a document with their oncologist’s name and phone number, chemotherapy regimen information and associated dates and schedules, and potential side effects. This included information on which side effects may require an ER visit.

Implementation of the system exceeded the goal, reducing ER visits by 60%. Patient calls into the PAC increased as well, and experience with the triage system allowed creation of further materials that could aid in future versions of this initiative.

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

“The overuse of [ERs] is driving up healthcare costs and can hurt the quality of patient care in many ways,” said ASCO spokesperson Gregory Masters, MD, of Helen F. Graham Cancer Center in Newark, Delaware. “This study shows that putting simple measures in place can significantly decrease ER visits, helping patients to get the care they need faster.”