Express Symptom Management Prevents Unnecessary Oncology ED Visits

This blog post is the first in a 6-part series highlighting the achievements of the 2023 ACCC Innovator Award winners before their in-depth sessions at the ACCC 40th National Oncology Conference. You can learn more about the innovations being recognized this year and those who pioneered them by joining ACCC in Austin, Texas, from October 4-6, 2023. 

Of the estimated 131 million patients who visited the emergency department (ED) in 2020, only 14% were admitted into a hospital. This substantial strain placed on health care workers and organizations by unnecessary ED visits prompted Orlando Health Cancer Institute to develop their express symptom management program in July 2021. The program was designed to effectively triage and treat cancer related symptoms in the outpatient setting. Dana Salcedo, MSN, APRN, AGNP, outpatient infusion and express symptom management nurse practitioner, took the clinical lead on the project, and her team had one goal in mind: capturing patients before they presented to the ED. 

Program Implementation  

Upon inception, the express symptom management program was staffed by Salcedo and a triage nurse. “It was a literally a two-man show, then we expanded and hired a scheduler,” Salcedo explained. A second health care provider soon joined the team, allowing Salcedo to spend more time with patients. “A lot of patients felt like my time with them was rushed, and that bothered me,” she said. “Adding that second provider made all the difference.” 

To assist in fine tuning the program, a business intelligence dashboard was implemented to collect data on the patients with cancer who were presenting to the ED. Armed with this information, Salcedo and her team can now track unnecessary ED visits that could have been managed via express symptom management. The dashboard allows Salcedo and her team to track and monitor high-risk patients and measure their outcomes. “We are also able to help patients with cancer manage their symptoms over the phone, in person, or allow for direct admission when indicated,” Salcedo said. 

In 2022 and in partnership with the information technology department at Orlando Health Cancer Institute, the express symptom management team created a pre- and post-first infusion automated Epic MyChart message. This automated message is triggered by the system based on the patient’s scheduled chemotherapy appointment. They receive pre-infusion reminders and a post-treatment message. According to Salcedo, the message includes a self-management algorithm of the common treatment-related side effects patients may experience, as well as the necessary steps to manage those symptoms. For severe symptoms, patients can contact the express symptom management team for further evaluation. Currently, Salcedo and her team are working to launch a similar initiative for those patients who forgo using their MyChart to receive text messages or emails. 

Program Successes 

“When we extrapolated the data, there was only about 2% of patients who had gone to the ED that truly needed to be hospitalized,” Salcedo revealed. “The rest just needed supportive care.” According to Salcedo, the express symptom management program has improved and enhanced the outpatient clinic’s flow. Salcedo believes providers find comfort in knowing they have a resource available to their patients. Patients with cancer who present at Orlando Health Cancer Institute share a similar enthusiasm for the program. “The patients absolutely love it—they feel like they have an extra pair of eyes to help them at a moment’s notice,” Salcedo said. 

Salcedo asserts that the strategic partnership between the oncology and information technology departments—one she refers to as a “beautiful marriage”—has been instrumental to the program’s success. “Who would have thought non-clinical players would be the game changers for the future of healthcare,” she said.

At the ACCC 40th National Oncology Conference this fall, Salcedo will provide an in-depth analysis of Orlando Health Cancer Institute’s innovative express symptom management program. “As ACCC members attend the meeting this fall, they should know everyone is there for one goal: to aid patients in a fearful time. Our mission is to provide a measurable quality of care to all,” Salcedo concluded. To learn more about implementing an express symptom management program at your organization, including the technology and support staff needed to find success with such a program, register to attend the 2023 ACCC National Oncology Conference in Austin, Texas, from October 4-6, 2023.