Collaborating across Teams to Coordinate After-Hours Oncology Patient Care

Purpose: Create an early intervention process for acute medical conditions in oncology patients to efficiently move patients across levels of care to improve patient outcomes and decrease financial burdens. An after-hours triage program (AHTP) was established in October 2021. By February 2022, it was noted that the highest volume of patient phone calls were from oncology patients, which resulted in a large population being referred to the emergency room (ED). Telephone triage is essential in outpatient management of oncology patients to ensure they navigate to the appropriate level of care.

From February 2022 through June 2023, 778 oncology patient phone calls were managed by AHTP, with 35% (n=272) of patients referred to the ED. In June 2023, the after-hours triage program (AHTP) began a collaboration with the cancer center’s acute care clinic (ACC), an ambulatory care clinic that provides care for oncology patients with acute medical issues. Patients placing after-hours calls are triaged to determine the correct disposition of care with protocols embedded in the electronic medical record (EMR). ACC providers are paged for consults during their operational hours. For overnight calls, a high-priority EMR message is sent, and the ACC provider is paged the next morning. The outcomes of this collaboration have not previously been measured.

Description: Two registered nurses with more than 30 years of experience conducted a review of the current process of AHTP and evaluated the following variables: patient encounters, the volume of patients referred, the number of arrivals and patients seen, treatments received, and disposition of patients from the ACC.

Evaluation: After implementation of the AHTP/ACC collaboration from July 2023 through October 2023, AHTP managed 624 oncology patient calls and referred 35% (n=221) patients to the ED. AHTP referred 4% (n=25) of patients to ACC during this time period. Of the 25 patients referred, 76% (n=19) arrived at ACC for their appointment. Treatments for these patients included: IV hydration, fever management, pain control, and evaluation of upper respiratory symptoms. Of the patients referred to ACC, 79% (n=15) were discharged home, 11% (n=2) were directly admitted to the hospital, and two patients (11%) were transferred to the ED. An additional 61 encounters were identified as potential ACC referrals when the encounter disposition would have allowed for a visit during ACC operational hours. Further review is needed to validate these potential referrals, to prevent manageable symptoms from being referred to the ED.

Outcome: Data demonstrates that 75% of the patients are open to the ACC referral process and keep their scheduled appointments with the ACC. The AHTP collaboration was successful across levels of care between AHTP and ACC improving workflow, early intervention, and eliminating unnecessary ED visits. Additional interventions should focus on expanding ACC weekend hours and measuring patient outcomes with the expansion.