Reducing ED visits by “closing the loop” for symptomatic patients.

Abstract

100 Background: Improving the value provided to patients and payers in our system of cancer care relies on reduction of avoidable hospital and emergency department (ED) utilization. Furthermore, recent payer pressures on community oncology practices (COPs) have resulted in an increased focus on improving care coordination (CC) under strict resource constraints. As part of the ASCO Quality Training Program, we tested several low-cost CC interventions, leveraging workflow redesign, already employed care team members, and technology already implemented, to reduce ED visits (EDV) in a single large COP clinic where more than 3,200 cancer patients were treated during 2016. Methods: Baseline EDV rates were obtained through nurse chart review during Jan.-Jun. 2016. The following CC interventions were implemented: Initiated after hours call process with access to EMR and patient access to bidirectional real-time messaging with care team members; Implemented new in-office process to “close the loop” on patient evaluations by creating follow up guidelines for symptomatic telephone triage and in-clinic patient evaluations; Implemented a standard 48 hour follow up process for all EDV and hospital admissions; Increased patient awareness of telephone triage services during and after clinic hours by: augmenting new patient education by staff, developing a magnetic reminder to call the office for non-emergent and emergency situations, and instructions for use of afterhours call system. Nurse chart reviews were conducted throughout implementation to observe effects of new CC processes on EDV. Results: We observed a 30% reduction in EDV from baseline measurement. No new FTEs added and no new technology licenses acquired for this initiative. Conclusions: Low-cost CC interventions can be implemented in COPs to avoid ED utilization. Limitations of this analysis included manual chart abstraction that could not account for EDV outside the partnering health system, illustrating data access for hospital utilization remains a major challenge for quality improvement efforts for COPs. Additional challenges have been experienced in expanding these process improvements from a single large clinic to the broader Tennessee Oncology network of more than 30 clinics.