The emergency department (ED) is often the only option for patients with cancer when they experience acute symptoms and toxicities. In a presentation at the inaugural ONS Bridge™ virtual conference, speakers discussed an alternative to the ED: oncology-specific urgent care centers.
Suzanne McGettigan, MSN, CRNP, ANP-BC, AOCN®, Carrie Peterson, DNP, RN, AGNP-C, and Kristen Reeb, MS, RN, ANP-BC, illustrated the need for such centers with a quote from the husband of a patient with cancer from 2011: “You’re doing her a disservice by sending her to the ED. We can see the cancer center, and we’re not there. It’s an assault on our well-being.”
The Emergency Department
The speakers said that the ED can be a high-risk setting for patients with cancer who are immunocompromised, and physicians in the ED may not have oncology-specific expertise. In the ED, patients with cancer may face costs related to unnecessary testing, interventions, and prescriptions. In addition, the average wait time in the ED is six hours, the speakers said.
According to the speakers, of patients who are recipients of Medicare and are undergoing chemotherapy, more than half visit the ED at least once a year. In addition, two-thirds of ED visits lead to admissions; the average cost of an ED visit is $800, and the average cost of admission is $22,000.
Treatment for cancer contributes more to healthcare costs than treatment for any other disease, according to the speakers. The average out-of-pocket cost with a new cancer diagnosis is $2,116 for Medicaid beneficiaries and $8,115 for Medicare beneficiaries. In addition, 46% of cancer care costs are associated with hospitalization, they said.
Under the Centers for Medicare and Medicaid Services Hospital Outpatient Quality Reporting Program, measure OP-35: Admissions and ED Visits for Patients Receiving Outpatient Chemotherapy tracks patients with cancer risk having an ED visit or inpatient admission for 1 of 10 conditions (anemia, nausea, dehydration, neutropenia, diarrhea, pain, emesis, pneumonia, fever, and sepsis) within 30 days of receiving outpatient chemotherapy. The speakers said that the goal is to assess the care of patients with cancer and reduce avoidable admissions and ED visits in patients with cancer receiving chemotherapy in the outpatient setting.
Oncology-Specific Urgent Care Centers
According to the speakers, some of the benefits of oncology-specific urgent care centers include fewer ED visits and avoidable admissions, continuity of care, patient- and family-centered care, and improved safety and experience for patients with cancer.
“It is important to keep our patients with cancer out of the ED because of the risk for infection, the risk for unnecessary tests, and the oncology-specific care that they need; this need is really highlighted even more by the current COVID-19 pandemic,” McGettigan said. “More than ever, we need to identify and create safe spaces for patients to receive oncology-directed symptom management care.”
The speakers said that the scope of services for oncology-specific urgent care centers includes:
- Screening, diagnosing, stabilizing, and treating patients with cancer who have urgent care problems
- Determining suitability for discharge to longitudinal providers or admission with appropriate referrals
- Providing daily observation for identified patients through scheduled visits to avoid ED visits or unnecessary admissions
“This concept is applicable to nurses in all patient settings,” McGettigan said. "When patients with cancer are not feeling well, it is often related to their cancer diagnosis or treatment; oncology providers have the knowledge and clinical skills to effectively treat these symptoms and to provide patient education in the ambulatory or home setting.”