Triage system reduces ED use for cancer pain management

A multifaceted intervention strategy designed to recognize adverse events in patients with cancer reduced ED visits during offices hours 60%, according to study results presented at the Quality Care Symposium.

The overuse of the ED by patients with cancer is a known problem, leading to increased admission rates and health care expenditures, according to study background.

Brian Hunis, MD, medical director of quality initiatives and the head and neck cancer program at Memorial Cancer Institute in Hollywood, Florida, and colleagues found that between January 2015 and May 2015, 48% of ED visits at their institution made by patients with cancer occurred during regular office hours.

In an attempt to decrease ED visits 30% by September 2015, Hunis and colleagues developed a rapid cycle quality improvement project aimed at creating a project map for triage and patient scheduling.

The researchers designed a cause-and-effect diagram to identify potential causes of ED use. They also obtained diagnostic data from electronic medical records (EMR) of ED visits, which indicated patients with breast, hematologic or gastrointestinal cancers appeared most likely to use the ED. Reasons included treatment-related pain, diarrhea, nausea and fever.

Using these data, the researchers created two plan-do-study-acts (PDSA) to reduce ED visits.

The first PDSA involved the development of a telephone-based protocol system, in which telephone operators were trained to assess the severity of patient-reported symptoms and determine whether an ED referral should be recommended.

This system also used the skills of a triage nurse and encouraged participating oncology practices to add walk-in hours to their daily schedules.

The second PDSA involved patient education on chemotherapy-related adverse events, as well as tips on how to handle issues arising after office hours.

According to the researchers, the implementation of these triage strategies resulted in a 60% decrease in ED use by patients with cancer, which met the study’s endpoint.

They further reported an increase in patient calls to the patient access center telephone operating service.

Hunis and colleagues also have developed new materials for patient use. These include a telephone triage form that categorizes patient complaints and the resulting action taken by the patient access center, as well as a patient clinical intervention triage tracking log, which tracks all patients triaged, their data and the employees involved.

“By implementing this new system, our goal was to reduce unnecessary patient discomfort, interruptions in treatment and financial burden,” Hunis said in a press release. “This triage system is applicable to all patients on active treatment, regardless of the type of therapy they are receiving. We believe that other oncology practices could easily mimic our model.” – by Cameron Kelsall

Reference:

Hunis B, et al. Abstract 51. Presented at: Quality Care Symposium; Feb. 26-27, 2016; Phoenix.

Disclosure: Memorial Healthcare System funded this study. Hunis reports stock ownership in Celgene. One other study researcher reports institutional research funding from Boehringer Ingelheim, Genentech/Roche, Merck Serono, Novartis and Pfizer.