Background
Oncology patients with hematological or solid organ malignancies have limited access to their clinical team after hours, leading to increased use of emergency services and avoidable hospitalizations. A pilot project, CAREchart, employing a nurse-led after-hours telephone service, reduced emergency department (ED) visits and was subsequently implemented across Ontario, including at the Juravinski Cancer Centre (JCC) in Hamilton, Canada.
Methods
In this retrospective cohort study, data were abstracted from electronic records, including patient and disease characteristics, reason for calling, and outcomes of the call between Oct 2019 and April 2021. Patients included were aged 18 or older receiving systematic/radiation therapy at JCC. The primary outcome was the proportion of patients accessing CAREChart who were referred to the ED and admitted to the hospital. Secondary outcomes covered the impact of the COVID-19 pandemic wave 1 and 2 on the primary outcome.
Results
A total of 636 calls were made to the CAREChart program from October 2019 to April 2021. Among these, 199 (31.3 %) of calls were directed to ED, 154 (24.4%) visited ED, out of which 93 (14.6%) required admission. This finding was consistent across different time periods: pre-COVID-19, COVID-19 Wave 1, and COVID-19 Wave 2, with 30.8%, 30.8%, and 31.7% of patients directed to the ED, respectively. Similarly, 10.8%, 15.4%, and 15.6% of patients required admission during the pre-COVID-19 period, COVID-19 Wave 1, and COVID-19 Wave 2, respectively. Forty patients (6.3%) visited the ED, and 27 required admission (4.2%) when they were not initially advised to go to the ED through CAREChart.
Conclusions
The CAREChart program provides a unique avenue for JCC cancer patients to access care after hours. The program was successful in avoiding >65% of potential ED visits thus reducing hospitalizations in these patients.
No relevant conflicts of interest to declare.
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