A Guide to Establishing an Oncology Urgent Care Clinic

For patients with cancer who experience treatment-related symptoms, emergency department (ED) visits to manage symptoms may occur frequently, contributing to long wait times, unplanned hospital admissions, and possible interruptions in cancer treatment. Studies estimate that 20%-60% of ED visits among patients receiving cancer treatment could be managed outside the ED or hospital setting. Oncology urgent care clinics, created to manage nonemergent conditions in an outpatient setting, are an increasingly recognized solution. The University of Texas Southwestern Harold C. Simmons Comprehensive Cancer Center (SCCC) consistently noted difficulty accommodating same-day appointments for patients experiencing acute symptoms, often leading to ED referrals. In response, SCCC developed a same-day appointment option for patients experiencing acute medical concerns: Simmons Acute Care (SAC). The goal was to address nonemergent acute issues, thereby reducing avoidable ED visits and improving the quality of care. Early planning with a multidisciplinary team focused on identifying factors that contributed to ED visits, with these findings serving as the core of SAC planning. A pilot study was implemented to evaluate the feasibility and identify the challenges for SCCC patients who were receiving any cancer treatment modality, or who had completed treatment within the past 90 days. Conditions appropriate for outpatient management were identified through a literature review and assessment of the U.S. Centers for Medicare and Medicaid Services definition of potentially preventable ED visit diagnoses. Nine clinical pathways were developed to provide evidence-based care. A fast-track laboratory courier system and expedited imaging were incorporated into the process model. A dashboard to identify clinical outcomes, process measures, and trends was created to track real-time data and provide monthly updates to core staff. The dashboard tracked key metrics while maintaining engagement and identifying needs for additional resources. Notably, current data reflect that 75%-80% of SAC encounters are seen and discharged home with a next-day follow-up call by a registered nurse. Approximately 15% of the SAC encounters are directly admitted to the hospital, bypassing the ED. These data reflect a response to the evolving complexity of cancer care and patient care needs by offering a rapid connection to an experienced care team. SAC is now the standard pathway for oncology patients who meet the criteria.