Identifying patients at high-riskfor unplanned acute careallows oncologists to focus their resources on specific populations who may benefit from additional support. Examples of this intervention include stratify patients with established risk-stratification models and predictive analytics, and monitor patients with known risk factors accordingly.

Enhance access and care coordinationby providing flawless and reliable ways patients can contact their care team, develop patient navigator programs, and improve and standardize transitions of care.According to the researchers, many unplanned ED visits were the result of patients having a need to talk with their treating physician.

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Standardized clinical pathwaysfor symptom managementcan reduce unplanned acute care by integrating supportive care in various areas. This may involve acute symptom management and telephone triage systems, disease management pathways that incorporate supportive care, and symptom management pathways for the ED.

Develop new loci for urgent cancer careinstead of automatically admitting those patients who present to a general ED to the hospital. These patients often present during normal clinic hours, so directing them to an alternative setting for care may be feasible. Possible interventions the authors suggest include establish an area for acute cancer observation and treatment within the clinic, embed cancer care clinicians in the ED, or establish a dedicated cancer ED. 

Use of early palliative care,which is now recommended for all chronic or long-term diseases and patient situations, not only cancer. According to the researchers, there should be standardized education regarding symptom management, end-of-life discussions, guidelines for inpatient and outpatient consultation, embedded outpatient palliative care clinics, and integrated inpatient palliative care/oncology units.

The authors call for further research and evaluation to identify the optimal strategies that would reduce ED visits, hospitalizations, and rehospitalizations for patients with cancer.


Bette Weinstein Kaplan is a medical writer based in Tenafly, New Jersey. 


Reference

Handley NR, Schuchter LM, Bekelman JE. Best practices for reducing unplanned acute care for patients with cancer. J Oncol Pract.2018;14(5):306-313.