Physician Assistant UT Southwestern Harold C. Simmons Comprehensive Cancer Center
BACKGROUND Due to disease burden and treatment-related side effects, more than 53% of oncology patients visit the emergency department (ED) for symptoms that could be best managed in outpatient settings. Many cancer centers across the United States have implemented urgent or acute oncology care clinics (ACCs) led by advanced practice providers (APPs) to decrease ED visits and to provide prompt high-quality care. To monitor and measure patient outcomes and to present findings to improve decision making, a visual dashboard report was generated to assess the impact on oncology patients and to measure clinical outcomes.
METHODS A multidisciplinary team consisting of oncology APPs, nurses, pharmacists, and cancer center leadership identified key performance measures. To ensure the quality of the measures, the APP team collaborated with a quality improvement analyst to establish the definitions and business rules for each measure. Based on the ACC department identity code, data from appointments are extracted from the storage warehouse of electronic medical records (EMR) using structured queried language (SQL) and are uploaded into Tableau, a user-friendly analytic tool, which creates visual graphs and tables to generate the dashboard. Key performance measures are updated monthly and visualized on dashboard.
RESULTS Dashboard measures included: daily patient volume, length of stay, chief complaint, diagnoses, patient disposition (home, direct admission, ED transfer), orders entered, primary cancer diagnosis, ED visit within 72 hours of an ACC visit, and the referring disease-oriented team. From August 2020 to June 2022, a total of 1,842 patients were seen in the ACC. Of these visits, 78 patients presented to the ED within 72 hours of ACC visit, with 59 ED visits having occurred when the ACC was closed. The average length of stay in clinic was 3.19 hours. The most common presenting chief complaints were gastrointestinal symptoms (367 visits) followed by weakness/hypovolemia (189 visits). The most common imaging orders placed were plain films and computed tomography (CT) scans. The most common labs ordered were complete blood count with differential and comprehensive metabolic panel.
CONCLUSION The ACC dashboard enables APPs and key stakeholders to measure and compare patient outcomes, as well as resource allocation. Patient volumes, timing of visits, and the type of diagnostic test ordered facilitate strategic planning for future patient needs. Retrospective analysis of patient data also demonstrates an overall reduction and prevention of ED visits. The dashboard has also assisted in evaluating the quality of care provided and identified opportunities for improvement with the clinic.
IMPLICATIONS Dashboard data has provided a platform to engage the acute care APP team and identify interventions and preventative measures in the outpatient setting to help minimize ED visits for patients with cancer. The dashboard has also helped imaging, laboratory and pharmacy partners anticipate and plan for future needs to improve patient care.
