Nurse-led emergency department avoidance model of care for patients receiving cancer therapy in the ambulatory setting: a health service improvement initiative

Abstract

Aims The Symptom and Urgent Review Clinic was a service improvement initiative, which consisted of the implementation and evaluation of a nurse-led emergency department (ED) avoidance model of care. The clinic was developed for patients experiencing symptoms associated with systemic anti-cancer therapy in ambulatory cancer settings. Methods The clinic was implemented in four health services in Melbourne, Australia across a six-month period in 2018. Evaluation was by prospective data collection of the frequency and characteristics of patients who used the service, pre- and post-survey of patient reported experience, and a post-implementation survey of clinician engagement and experience. Results There were 3095 patient encounters in the six-month implementation period; 136 patients were directly admitted to inpatient healthcare services after clinic utilization. Of patients who contacted SURC (n = 2174), a quarter (n = 553) stated they would have otherwise presented to the emergency department and 51% (n = 1108) reported they would have otherwise called the Day Oncology Unit. After implementation, more patients reported having a dedicated point of contact (OR 14.3; 95% CI 5.8–37.7) and ease of contacting the nurse (OR 5.5; 95% CI 2.6–12.1). Clinician reported experience and engagement with the clinic was highly favorable. Conclusion The nurse-led emergency department avoidance model of care addressed a gap in service delivery, while optimizing service utilization by reducing ED presentations. Patients reported improved levels of satisfaction with ease of access to a dedicated nurse and advice provided.

Protocol for a mixed methods process evaluation for a nurse-led model of care (SURC) to support individuals receiving systemic anti-cancer therapy

“…Urgent Cancer Care models implemented in countries such as the US, UK and Italy, have been shown to reduce access barriers to care (10), as well as reduce hospitalisations and associated health care costs (11). In response to a growing recognition that individuals receiving systemic anti-cancer therapy (SACT) require timely access to specialist cancer support and advice (12,13) to prevent sub-optimal health and system-level outcomes, a nurse-led model of care initially developed in 2013 (14,15), was expanded and piloted at a number of healthcare organisations across Victoria, Australia from 2017-2020 (15). The Symptom and Urgent Review Clinic (SURC) model of care was implemented with the primary aim of creating a timely and accessible point of contact for patients and caregivers of patients receiving SACT in the ambulatory setting (15,16).…”

“…In response to a growing recognition that individuals receiving systemic anti-cancer therapy (SACT) require timely access to specialist cancer support and advice (12,13) to prevent sub-optimal health and system-level outcomes, a nurse-led model of care initially developed in 2013 (14,15), was expanded and piloted at a number of healthcare organisations across Victoria, Australia from 2017-2020 (15). The Symptom and Urgent Review Clinic (SURC) model of care was implemented with the primary aim of creating a timely and accessible point of contact for patients and caregivers of patients receiving SACT in the ambulatory setting (15,16). The model primarily includes nurse and/or patient-initiated telephone support from specialist cancer nurses with access to nurse-led physical review where required.…”