The overuse of emergency room (ER) services by patients with cancer is associated with decreased quality of patient care and increased costs, and an initiative at Memorial Healthcare System in South Florida has been shown to be highly effective in solving this problem, according to early results from a new study.
The new system — the first of its kind according to study authors — used a telephone triage service and patient education to decrease the use of ER services by 60 percent in just four months.
More detailed study results will be presented at the American Society of Clinical Oncology’s (ASCO) 2016 Quality Care Symposium on Feb. 26.
“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 ER visits occurred during office hours of the five public hospitals of the Memorial Healthcare System. Patients with breast cancer, hematologic malignancies and gastrointestinal malignancies were identified as the main users of ER services. The most common reasons for ER visits were pain, diarrhea, nausea and fever.
Following this analysis, a multidisciplinary physician team worked to develop a protocol for telephone operators to assess patient symptoms and determine when a referral to the ER 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 percent reduction in the number of patients utilizing ER 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.”
This is a very interesting article that focuses on an ever-growing issue in American healthcare. Regarding the "frequent flyers" for oncology-related ER visits mentioned here, it is interesting that most are issues GI-related (e.g. mucositis) and/or associated with chemo-induced immunosuppression. It would be interesting to know how many of these issues could be thwarted or at the very least minimized by simply reducing the intra-oral bacterial load before immunosuppressive therapy. That is to say, simply getting your teeth cleaned and periodontal health in check and getting any broken or infected teeth taken care of before beginning a treatment that significantly lowers the body's immune system may reduce this call volume even more. We have definitely seen a significant reduction of these types of emergencies in the patients we serve. - Dr. Dennis Abbott, Dental Oncology Professionals
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