Most cancer patients will suffer severe symptoms at some point during their treatment and turn the the ED for care. Unfortunately, the ED is not the ideal place to manage cancer patients’ symptoms.

To help cancer programs better manage cancer patients with urgent care needs, we identified four tactics in this study for improving urgent symptom management.

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Many EDs struggle with overcrowding and consequently patients may have to wait for hours. In the process, they may be exposed to pathogens, which is aparticular concern for immunocompromised cancer patients. Few ED clinicians have oncology-specific training, which canlead to unnecessary hospitalization, inappropriate utilization of services, and lower quality care. As cancer centersbecome increasingly responsible for both improving the patient experience and reducing avoidable costs, providing urgentcare in the most appropriate setting is becoming a top priority.

According to responses to the Oncology Roundtable’s 2013 Engineering an Exceptional Patient Experience Quick Poll,most programs have either ineffective or inadequate urgent symptom management programs. Only 20% of cancerprograms provide support for patients with urgent symptoms after business hours. In fact, 27% of programs say theyroutinely send all patients with urgent symptoms straight to the ED. To help our members build a strategy for urgentsymptom management, we have outlined four key tactics for meeting the needs of patients with urgent symptoms.

Tactic 1: Implement standardized telephone triage

At a minimum, cancer programs should operate a phone line that patients can call to receive immediateassistance if they have urgent symptoms. Programs should ensure that the line is staffed with anadequate number of well-trained staff who are able to address patients’ urgent care needs over the phoneor guide them to the most appropriate care setting.

This first tactic is applicable to all cancer programs, although the scale will vary depending on the size and complexity ofthe patient population. In contrast, the following three tactics will be more appropriate for programs struggling to managehigh volumes of patients seeking same-day care in their facilities.

Tactic 2: Implement flexible scheduling systems

In many cases, clinicians can free up time to see urgent patients during the day by transitioning to moreflexible scheduling systems. There are several systems administrators may wish to examine, ranging fromblocking add-on patient time in each provider’s schedule all the way to implementing an open-accessscheduling system.

Tactic 3: Deploy advanced practice providers

Although many cancer programs employ advanced practice providers (APPs), they are oftenunderutilized by oncologists. To ensure APPs are deployed appropriately, programs may need to educatephysicians about APP skills and scope of practice, and remove financial disincentives that discouragephysicians from referring to them. In contrast, if a program’s physicians lack the capacity to addresspatients’ urgent symptoms, they may want to hire one or more APPs.

Tactic 4: Create dedicated space for urgent care

Programs with a high volume of regular appointments and significant demand for urgent add-onappointments may want to create a dedicated facility for urgent cancer care outside of the cancer center.Though the initial investment is large, early movers have seen significant benefits in terms of reduced EDvisits and improved market differentiation.

This publication will explore the mandate to provide timely, evidence-based symptom management as well as the varioustactics cancer programs are deploying to achieve it.

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