Nurse initiative: In essence, the science of oncology has outpaced the healthcare system and the conventional delivery of care. While patients are living longer than ever before, innumerable days are spent suffering with uncontrolled symptoms or receiving acute treatment in emergency departments and inpatient hospitals, adding emotional, financial, and personal burden to patients and their families. This gap between conventional cancer care models and the progression of cancer science has necessitated the creation of new and innovative care delivery models aimed at improving the value, experience, and delivery of oncology care. Implementation strategies: In response to this need, a multidisciplinary urgent care was developed to provide urgent care services and advanced symptom management tailored to the unique need of oncology patients. Directed by a nurse practitioner and led by nurses practicing at the top of scope, the clinic utilizes a collaborative model of hospitalist and oncology trained advanced practice providers, in partnership with acute-care and oncology trained RNs, to provide a high-quality, cost-effective, patient-centered alternative to the emergency department. Evaluation of the impact/effectiveness of the organization: Since 2019, the CARE clinic has reduced rate of 30-day preventable ED visits by nearly 50%, and volumes have expanded rapidly, with a >40% increase in year-over-year volume in the last 2 years. Approximately 40% of patients report that the would have sought care in the ED if the CARE clinic had not been available, and over 99% of patients rate their visit as "excellent" or "good." Implications for nurse practice: The healthcare system is rapidly changing. Rising costs, capacity issues, and increased emphasis on patient experience necessitates innovation and change, and our clinic has led the way. The model has gained national attention, with numerous organizations seeking to replicate and implement similar models within their own institutions. In addition to the oncology patient population, this model has opportunity to expand to other high-utilizing complex patient care populations, including transplant, heart failure, COPD, and so many more.
