The impact of a nurse practitioner-led symptom clinic on emergency department use in cancer patients

Abstract

Te impact of a nurse practitioner-led symptom clinic on emergency department use in cancer patients E mergency department (ED) use and hospitalization across the continuum of cancer treatment are common and distressing issues for patients and their families. Use of these services is recognized as an indicator of poor quality end-oflife care, but studies have demonstrated frequent use of them in patients with advanced cancer and particularly in those who are close to the end of life. 1-3 Tere is growing evidence that more than 50% of ED visits are secondary to cancer symptoms and that nearly 23% of visits could be avoided. 4,5 Early identifcation of these patients and aggressive outpatient symptom management may reduce ED use and hospitalization. Tis improved quality of care could also have a positive impact on the high cost of end-of-life cancer care. Diferent models of care have been explored to provide outpatient supportive treatment to cancer patients, including nurse practitioner (NP)-driven symptom management clinics. In this study, we explored the characteristics of high users of emergency department services and the impact of an NP-led, physician-supervised, symptom management clinic on the total frequency of emergency department visits. Methods We conducted a retrospective review of ED encounters to improve quality of care and quantify the frequency of ED use by cancer patients at a community cancer institute. Te review period was from October 1, 2012 to September 30, 2013, and a total of 425 patient charts were audited to evaluate ED use by patients who were actively receiving chemotherapy, radiation therapy, or combination therapy. Chart abstractions were completed for each encounter to determine if the patient had received cancer treatment within 30 days of the ED visit. Only patients who were receiving active treatment were included

Impact of a Dedicated Cancer Urgent Care Center on Acute Care Utilization

“…To date, multiple oncology programs have established a dedicated urgent care facility with some, [28][29][30][31][32][33][34][35][36][37][38][39][40] but not all, [41][42][43][44] publishing their infrastructure. While three represent satellite urgent care or observation units embedded within fully staffed, continuously operating, standalone cancer hospital EDs, 28,29,35 the remainder are dedicated clinics affiliated with either a cancer center or a large oncology practice that are simultaneously served by a general ED.…”

“…Scope of practice, however, spans the spectrum from moderate-to-high-acuity urgent care [30][31][32][33][34]39,41,42,44 to facilities limiting services to supportive care (eg, hydration and transfusions). 36,38,40 The Smilow OECC, however, is among the only three high-acuity sites where APPs are the primary providers 33,44 and is the only APP-driven site with extended hours 365 days of the year. Four high-acuity centers have applied robust statistical modeling to assess impact on ED utilization or hospital admission.…”

Patterns of Support Service, Emergency Department, and Hospital Utilization in Patients with Advanced Cancer: A Descriptive Study

“…healthcare that focuses on optimal management of pain and other symptoms while incorporating psychosocial and spiritual care according to patient/family needs, values, beliefs and cultures.'' 1 This philosophy has been implemented in a variety of ways in oncology practices around the world [2][3][4][5][6][7][8][9][10][11][12][13][14] and has been shown to improve patient outcomes, including decreased symptom severity, improved quality of life, and in some cases, decreased utilization of emergency department (ED) and hospital admissions. [15][16][17] The study by Temel et al (2010) showed improvement in quality of life, and notably increased survival in patients with advanced lung cancer when palliative care was introduced early in the course of illness.…”

Review of advanced practice nurse role in infection throughout the hematopoietic stem cell transplant journey

“…Sivendran et al examined a NP led, physician supervised, outpatient symptom review clinic for oncology patients in the ED. Although the primary population in this patient cohort were patients with advanced cancer undergoing chemotherapy, rather than HSCT recipients, 12.7% of patients presented with fever and were safely managed by the NP led clinics, with 95% of the patients presenting with acute symptoms, avoiding hospitalization 42. Hackett and Dowling evaluated the experiences of adult patients who had undergone lymphoma therapy through a nurse led consultative program.…”