Development of evidence-based clinical pathways for an outpatient oncology acute care clinic.

Abstract

e18676 Background: Oncology patients frequently experience acute physical symptoms related to cancer and its treatment. Management of symptoms is best accomplished using evidence-based clinical care. When implementing an advanced practice provider (APP)-led oncology acute care clinic, evidence-based clinical pathways were developed to ensure standardization among treating providers. Methods: The top ten emergency department admitting diagnoses for oncology patients identified by the Centers for Medicare and Medicaid Services provided the foundation for development of the clinical pathways. Relevant primary literature, National Comprehensive Cancer Center Network guidelines, and American Society of Clinical Oncology guidelines were reviewed for development of outpatient oncology acute care clinical pathways. The information was cross-referenced with institutional data to confirm applicability to the patient population. A multidisciplinary team including nursing, pharmacy, laboratory services, radiology, information technology, and administrative staff reviewed the workflow to ensure best processes. The pathways were reviewed by oncologists, APPs and pharmacists before finalization. Results: Nine evidence-based clinical pathways were developed by August 1, 2020. From August to December 2020, 165 patient visits took place in the outpatient oncology acute care clinic. Gastrointestinal manifestations (25%), hypovolemia/weakness (25%), and infections (17%) were the most frequently encountered symptoms. Evidence-based clinical pathways were followed for patients with a chief complaint with an associated algorithm (N=124). Conclusions: Implementation of clinical pathways facilitate best practice standardization when ordering labs, tests, and medications while enhancing the acceptance of the new service. The pathways will be reviewed and updated by a multidisciplinary team every 3 months to ensure current evidence-based practices. Semi-annual pathway audits have been implemented to evaluate utilization and optimize patient outcomes, as well as determine areas of improvement and growth. Areas of opportunity identified during the first pathway audit included creating pathways for cardiac disorders, mouth disorders, and infections unrelated to neutropenia. Additionally, order set integration to automate the clinical pathway process in the electronic medical record is in progress.[Table: see text]