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By Tina Curtis, DNP, MBA, RN
The Froedtert & the Medical College of Wisconsin Clinical Cancer Center is a busy treatment center at Froedtert Hospital, one of the largest hospitals in metropolitan Milwaukee. As part of an academic medical center and the five-location Froedtert & MCW Cancer Network, we’re well-resourced to meet the complex needs of our cancer patients.
However, we faced an issue common to many cancer programs. The needs of our patients extended beyond our clinic hours. When patients had symptoms needing prompt medical care after hours, they sought emergency care for treatment-related conditions, resulting in emergency department overutilization, unnecessary tests, and hospital admissions.
A patient chart review helped us understand patients presenting to acute care sites like the emergency department. Most arrived between noon and 10 pm, and, at one site, about 65 percent arrived by car, meaning they were stable enough to forego emergency transport. About 50 percent were admitted to the hospital from the emergency department. A significant number of admissions could have been avoided with appropriate outpatient follow-up, such as getting lab values rechecked, PICC lines maintained, or symptoms managed.
Our research resulted in the decision to combine two inpatient rooms adjacent to an oncology inpatient unit to create a 24-hour outpatient cancer clinic offering treatment for symptoms like fever, dehydration, nausea, mouth sores, bleeding, and fatigue. Oncology-specific providers would include infusion room nurse practitioners, oncology nurses, and technical staff.
In addition to patients who are treated and sent home, our 24-hour clinic can accommodate those who need longer-term care like overnight observation plus fluids and pain medication. Patients are able to access the clinic with a call to their doctor for a referral. Those with serious conditions like chest pain or stroke symptoms are sent to the emergency department. Watch our video for more.
Since the Froedtert & MCW 24-Hour Cancer Clinic opened in 2016, we’ve served more than 2,500 patients—approximately 140 each month. While we haven’t yet seen a change in emergency department use, the clinic is admitting 14 percent of patients to the hospital versus the emergency department admission rate of 51 percent. Lab orders are down by 20 percent, and diagnostic test charges have dropped by $757.
Best of all, patients have expressed a high level of satisfaction with the 24-Hour Cancer Clinic where providers immediately understand their needs, address them, and in many cases, send them home rather than admitting them to the hospital.
We’ll be presenting more on our ACCC Innovator Award winning program at the 2018 ACCC National Oncology Conference in Phoenix, AZ, Oct. 17-19, to share our learnings with others interested in implementing a similar program in their communities.
Guest blogger Tina Curtis, DNP, MBA, RN, is Executive Director, Froedtert & MCW Clinical Cancer Services.