Emergency department (ED) visits by patients with cancer can be unnecessary, costly, and potentially dangerous. Most symptom management concerns can be safely and quickly handled in the outpatient setting, but provider access can be a barrier.
A study found that the implementation of infusion center-based, advanced practice provider (APP)-led symptom management intervention visits increased access to care, decreased the need for symptom management, and decreased ED visits. Sara C. Syvinski, MSN, RN, ANP-BC, OCN®, NE-BC, presented the results in “Infusion Center-based APP Role Reduces Emergency Department Visits for Symptom Management in the Adult Oncology Population” as part of the e-poster sessions on November 2 and 3 during the 2018 JADPRO Live conference in Hollywood, FL.
Syvinski classified the following patients as high-risk: those receiving first-time chemotherapy for a thoracic diagnosis, those with a need for symptom management, or those with a hypersensitivity reaction. She identified patients through referrals from clinic triage, RNs and doctors, and APP chart review. Symptom management ED visits were defined as those with a primary oncologic diagnosis and a secondary diagnosis of dehydration, nausea, vomiting, diarrhea, weakness, fatigue, pain, constipation, shortness of breath, fever, edema/swelling, headache, or medication refill. The visits were classified as resolvable (the patient was discharged home from ED) or unresolvable (the patient was admitted from ED).
Symptom management outpatients received a follow-up phone call or in-person visit from the APP within 48 hours of the initial encounter in which they discussed resolution of symptoms, home care or medications, and patient comfort level. At this time, the patient could coordinate another appointment if further intervention was required.
The infusion center was set up as part of a large facility for acutely ill patients. It has 32 chairs and averages average 60–70 patients per day. The center is open from 7 am–6:30 pm Monday through Friday, and the APP is available from 8 am–4:30 pm each of those days. A medical oncologist is onsite at all times, serving as a backup and providing evening coverage.
The infusion APP meets all new patients prior to their first dose of chemotherapy and follows up via phone 5–10 days later, depending on the expected symptom pattern for each regimen.
Syvinski assessed data from visits occurring between June and August 2018 and compared it to ED data between June and August 2017. Forty-five patients visited the APP-led infusion center for hypersensitivity reaction (n = 15) or symptom management (n = 30): 39 were treated and discharged home from the infusion center with usual or no follow-up required; 3 were admitted to the hospital by the infusion center, not via the ED; and 3 required emergency transfer to the ED via emergency medical services for new-onset issues that required higher-level care. No patients were evaluated in the ED and discharged home from the ED.
ED data showed a decrease in total oncology visits from 2017 (n = 66) to 2018 (n = 52), as well as a decrease in oncology visits for resolvable symptom management complaints from 2017 (n = 36) to 2018 (n=15).
“The successful implementation of APP-led follow-up of high-risk patients [with cancer] has increased access to care and decreased the need for symptom management ED visits in this patient population,” Syvinski concluded.