Implementing a Validated Multi-Symptom Assessment Tool During Telephone Triage to Reduce Oncology Patient Emergency Room Visits.

Abstract

Cancer treatments induce multiple unwanted side effects that often go unrelieved, resulting in emergency room (ER) visits. Oncology clinics have established triage clinics (TCs) for symptom management, thereby improving access to care and decreasing ER utilization. In addition, evidence proves that validated patient-reported outcome (PRO) tools support improved symptom management and decreased ER visits. This quality improvement project aimed to determine if or to what degree implementing the MD Anderson Symptom Inventory (MDASI) tool decreases emergency room visits, with or without hospitalizations, in a South Florida outpatient oncology clinic. The MDASI tool was implemented in a TC during symptom management telephone triage. A statistically significant difference was observed in community ER visits and hospitalizations using a significance level of p < .05. The pre-implementation (n = 14, 29.8%) and post-implementation (n = 10, 23%) values (χ² [N = 47] = 12.66, p = .008) confirmed a reduction in ER visits by 6.8 percentage points. In addition, pre-implementation (n = 8, 17%) and post-implementation (n = 10, 21%) values (χ² [N = 47] = 25.69, p = .006) confirmed a mean increase of two more hospitalizations (4%) in patients after MDASI implementation, likely reflecting an improved patient understanding of appropriate ER utilization. The MDASI tool supported early symptom assessment and management while identifying patient knowledge gaps. This project confirms that PRO tools allow patients to assign meaning to their symptoms, improve communication, and reduce unnecessary ER visits.