Successful posthospitalisation oncology workflow implementing LACE+ score to stratify and reduce readmissions within a safety-net hospital.

Background: Patients with advanced cancers visit the emergency room and get hospitalised frequently, with potentially half of these visits being avoidable. Our institution provides comprehensive, low-cost cancer treatment to a safety-net population in Texas. We performed a retrospective review of hospital readmission patterns amongst our oncology patients and developed a posthospitalisation workflow to reduce readmissions.

Method: Following discharge, oncology patients were risk stratified based on their Length of stay, Acuity of admission, Charlson comorbidity index score and Emergency department visits+index in the past 6 months. The higher the score, the quicker the outpatient oncology follow-up. In addition to addressing acute issues related to hospitalisation, patients were also able to receive newly translated resources while in clinic.

Results: The preintervention 30-day-readmission rate was 17.3% (June 2022-December 2022) (95% CI 13.4% to 21.8%). Meanwhile, the postintervention 30-day-readmission rate was 14.7% (June 2023-December 2023) (95% CI 10.9% to 19.2%). While a 2.6% reduction in readmissions was achieved, this decrease was not statistically significant (-2.6%; 95% CI -8.4% to 3.2%; p value=0.375). Emergency use utilisation decreased from 90% to 15%.

Conclusions: Our team was able to facilitate and coordinate outpatient care for oncology patients following hospitalisation. The expedited care allowed providers to ensure that the care plan after hospitalisation was well understood and accessible to the patient. Furthermore, language-appropriate resources were provided to patients at that time. Our intervention was feasible, easy to implement and quick to produce tangible improvements in patient care. More time is needed to determine whether this will create a statistically significant impact on readmission rates.