Using Same-Day Urgent Care Visits to Improve Cancer Quality of Care (Spotlight Poster)

Learning objective: Evaluate the use of an oncology urgent care clinic to reduce emergency department (ED) utilization and readmission rates (RAR) for cancer patients.

Purpose: The purpose of this quality improvement project is to examine the impact of a cancer acute treatment (CAT) clinic for meeting the urgent health needs of cancer patients.

Description: About 15 million Americans suffer from cancer, accounting for 4.5 million ED visits annually. Aside from an ED encounter, same-day care for oncology patients was limited at our facility. An oncology urgent care clinic can reduce ED visits and lower healthcare costs for patients and facilities. Oncology costs represent a large and growing burden for the US healthcare system, with acute care hospitalization as one of the single largest drivers of overall cost. Increasing the number of oncology patients with urgent health problems who are treated in an ambulatory care setting is a priority of our cancer center. In October 2022 we opened a CAT clinic (staffed by an advance practice provider) as a pilot project within our oncology infusion center. This allowed patients who were experiencing acute issues to receive phone triage, and if appropriate, come in to be seen by a provider the same day.

Methods: We examined the following: 30-day unplanned readmission rates (RAR) for the business quarter prior to CAT implementation (RAR-Pre) and for 3 quarters after implementation (Q1; Q2; Q3); number of patients treated in the CAT clinic and discharged home versus being sent to the ED or admitted in Q1-3; top three infection diagnoses, labs, and medications ordered during CAT clinic encounters; and cost of CAT clinic encounters by dividing the total cost of all encounters over 12 months by the total number of patients seen during that time.

Evaluation/outcome: RAR-Pre for our patient population was 12.1%. CAT clinic implementation reduced RAR over Q1-Q3 to 11.1-11.9%. About 91% of CAT clinic patients were able to be treated in an outpatient setting and discharged home instead of being sent to the ED or being admitted (Q1: 91.6%; Q2: 93.75%; Q3: 87.5%; Mean = 90.95%). The average operational cost of an encounter in the CAT clinic was $347.64. The top three infection diagnoses seen included: COVID-19 rule out (30.9%), gastrointestinal infections (21.1%), and C. difficile (20.3%). The most frequently ordered labs were CBC/diff (77.2%), BMP (76.4%) and urinalysis/urine culture (24.4%). The most common types of medications ordered included intravenous fluids (53.7%), anti-emetics (22.8%), and electrolytes (16.3%). The CAT clinic has now been expanded after successfully reducing ED utilization and hospital readmissions for oncology patients.