Oncology urgent care to decrease unnecessary emergency room visits.

Abstract

212 Background: In March 2019, Columbia University Irving Medical Center (CUIMC)/New York Presbyterian (NYP) piloted an oncology urgent care center, Oncology Care Initiation Unit (OCIU). Patients currently on therapy were referred to OCIU Nurse Practitioners (NP) by primary Oncology Teams for acute, non-life threatening complaints for management. We evaluated the impact of the OCIU on preventing unnecessary emergency room (ER) visits, patient wait times, and patient satisfaction. Prior to the OCIU, 52% of oncology patients presenting to the ER were discharged indicating that an ER visit most likely was not needed. Average wait time for evaluation in ERs for non-critical patients is 7 to 9 hours and can be another 7 to 9 hours for intervention. Methods: We opened the 8-week OCIU pilot to Thoracic and Gastrointestinal (GI) Oncology, and Sarcoma patients who had an acute, non-life threatening complaint from, 8AM to 6PM, Monday to Friday. We collected data on all OCIU patient referrals from 3/7/2019 to 5/2/2019, including patient demographics, primary cancer diagnosis, chief complaint, wait times, interventions, disposition and patient satisfaction using a validated 5 question satisfaction survey. Results: During the pilot, we received 51 referrals, 44 (86%) were considered OCIU appropriate and evaluated; 25 (57%) had a GI cancer diagnosis, 14 (32%) Thoracic cancer diagnosis, and 5 (11%) Sarcoma. Primary chief complaints in order of frequency were pain, GI distress, and dyspnea. 44 (100%) had no wait to be evaluated by the OCIU NP. 33 (75%) of OCIU patients were discharged home, 9 (20%) were directly admitted, and 2 (5%) were transferred to the ER. Patients not requiring invasive intervention were discharged home within thirty minutes of their appointment. Patients requiring infusions, radiology services, and/or paracentesis or thoracentesis were discharged within 4 hours of appointment time. 100% patient satisfaction was reported. Conclusions: Implementation of the OCIU has led to decreased ER visits, wait times for evaluation and management, and increased patient satisfaction. These findings support the need for the OCIU, as well as increasing access to the OCIU by extending to additional HICCC patients.