Title

Implementation of a Rapid-Access Oncology Symptom Clinic Reduces Emergency Department Visits and Hospitalizations Without Increasing Short-Interval Returns: A Time-Series Analysis

Authors

Randa Elzein MD, Safa Elzein MD - Division of Hematology-Oncology, SUNY Upstate Medical University, Syracuse NY

Introduction

Treatment-related toxicities frequently trigger preventable emergency-department (ED) visits and hospitalizations among patients on chemotherapy or immunotherapy. We created a Rapid-Access Symptom Clinic (RASC) for high-risk oncology patients and evaluated its impact on acute-care utilization, safety, and cost.

Methods

High-risk patients (recent ED/hospital visit or grade = 2 toxicity) were offered same/next-day RASC appointments for assessment and management (labs, IV fluids, antibiotics, antiemetics, direct infusion access). ED visits and hospitalizations were compared 12 weeks pre- vs post-implementation using X² tests. Segmented interrupted-time-series (ITS) modeled weekly level and slope changes; 72-hour ED returns served as a balancing measure. Sustainment was tracked for 16 weeks post-pilot. Cost impact was estimated using average national charges for ED and inpatient encounters.

Results

Among 154 unique patients (188 visits), ED visit rate decreased from 28.4 % to 15.2 % (p = 0.002) and hospitalization rate from 18.7 % to 9.1 % (p = 0.004). Median time-to-RASC visit = 5.8 h; the proportion of symptomatic patients evaluated within 24 hours increased from 62 % to 91 % (p < 0.001). 72-h returns were unchanged (4.5 % vs 4.1 %, p = 0.79). ITS showed immediate level change –12.7 points (95 % CI –18.9 to –6.6; p < 0.001) and slope change –0.9 points/week (95 % CI –1.5 to –0.3; p = 0.004). Effects persisted through week 28. Estimated cost savings ˜ $110,000 per 100 patients over 12 weeks. No equity differences were observed by payer or race.

Conclusion

A rapid-access oncology symptom clinic achieved a 45 % reduction in ED visits and a 50 % reduction in hospitalizations without increased short-interval returns and sustained impact for six months. This equitable, low-cost model enhances patient safety and resource efficiency in ambulatory oncology.

References

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