Right care, right place: Improving urgent care for breast cancer patients on chemotherapy.

Abstract

e23229 Background: Breast cancer patients undergoing active chemotherapy frequently visit the Emergency Department (ED) with symptoms such as fever, pain, and nausea. While some visits are critical for addressing life-threatening conditions, others could be effectively managed in outpatient settings. MD Anderson Cancer Center (MDACC) ED created an Urgent Symptom Clinic (USC) to address the needs of these patients. This retrospective study, conducted by the Breast Medical Oncology Department at MDACC, analyzed short-stay visits of breast cancer patients undergoing chemotherapy to the oncology-specific Acute Cancer Care Center (ACCC) over a one-quarter period. The study aimed to identify the underlying reasons for these ACCC visits and explore opportunities to reduce non-emergent ED visits, such as directing patients to the USC. Methods: A retrospective chart review was conducted on breast cancer patients receiving chemotherapy who presented to the ACCC for short-stay visits, defined as those not resulting in subsequent observation or inpatient admission, from July 7, 2024 to October 18, 2024. Collected data included patient demographics, treatment regimens, and reasons for visits, categorized into seven groups: anemia, dehydration, diarrhea, fever, neutropenia, nausea, and pain. Referral sources were also assessed and included nurse triage (via a dedicated phone line), Epic InBasket messages, direct clinic referrals, and self-referrals. Adherence to MD Anderson’s USC referral criteria was evaluated to determine whether patients were appropriately referred to the ACCC or could have been directed to the USC. Results: An analysis revealed 45 breast cancer patients receiving chemotherapy presented to the ACCC resulted in a short – stay visit. The median patient age was 50 years, and the median time from chemotherapy to ACCC presentation was 6.76 days. The most common visit reasons were pain (55.6%) and fever (28.9%). Nearly half (46.7%) of the visits were self-referrals, followed by nurse triage line referrals (27%) and Epic messages (16%). According to MD Anderson’s USC referral criteria, 68% of these short-stay visits could have been appropriately managed at the USC, highlighting significant potential for improvement in reducing non-emergent ED visits. Conclusions: The majority of short-stay ACCC visits could have been managed by the USC with nearly half occurring as self- referrals without prior consultation with a healthcare professional. Next steps of interest include creating a standardized educational document for staff to optimize usage of the USC and encouraging patients to utilize triage lines which may reduce unnecessary ACCC/ED visits. This shift would alleviate strain on emergency services, optimize resource allocation, and enhance patient care by ensuring patients receive timely and appropriate treatment in the most suitable setting.