New Triage System Reduces ER Visits of Oncology Patients

Emergency room (ER) overutilization is a significant issue in oncology care and may increase healthcare expenditures while lowering the quality of patient care. In reviewing the number of ER visits between January and May of 2015, researchers noticed that only 48% of visits occurred during office hours.

The goal of the study, being published in the Journal of Clinical Oncology, was to reduce ER visits by 30%. The results are also being presented at the 2016 American Society of Clinical Oncology Quality Care Symposium.

“By implementing this new system, our goal was to reduce unnecessary patient discomfort, interruptions in treatment, and financial burden,” lead study author Brian Hunis, MD, said in a statement.

The researchers introduced a quality improvement initiative in order to address the overutilization of the ER for cancer treatment side effects, calling it the plan-do-study act (PDSA). PDSA #1 focused on a phone triage system, where center staff was trained to evaluate the severity of patient systems and decide when an ER referral was appropriate, with a triage nurse available for consultation.

PDSA #2 incorporated the education of patients on chemotherapy side effects and how to handle them when office hours were closed. Patients were also provided “chemotherapy passports,” depicting the oncologist’s name, contract information, chemotherapy regimen, date of last session, and potential side effects that might warrant hospital admission. They were encouraged to call the patient access center with any questions.

Other materials were later developed: a phone triage form describing the patient’s complaint and the patient access center response, and a log describing call-ins, their data, and which of the staff members was responsible.

This initiative was implemented at Memorial Healthcare System, which includes 5 public hospitals within southern Florida. As a result of this initiative, the team saw a reduction in ER services by 60%, 4 months after implementation.