1006 - The Impact of an Outpatient Urgent Care Clinic in Patients Treated for Head and Neck Cancer

E. Czarnecki¹, A. R. Bhatnagar¹, A. Mattour², S. Chang³, D. Kwon⁴, C. Ulreich², B. Movsas⁵, and F. Siddiqui¹; ¹Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI, ²Henry Ford Health System, Detroit, MI, ³Department of Otolaryngology, Henry Ford Cancer Institute, Detroit, MI, ⁴Department of Surgical Oncology, Henry Ford Cancer Institute, Detroit, MI, ⁵Department of Radiation Oncology, Henry Ford Health, Detroit, MI

Purpose/Objective(s): Emergency room (ER) visits and inpatient admissions are high among patients undergoing radiation therapy (RT) for head and neck cancers (HNC). These potentially expose immunocompromised cancer patients to nosocomial infections, disruption of treatment, and result in higher cost of care. Outpatient urgent care clinics specializing in the management of side-effects of cancer treatment may potentially reduce ER visits and admissions. We analyzed our experience before and after the establishment of this clinic (OncoSTAT) in our cancer center. Materials/

Methods: This is an IRB (IRB #8751) approved retrospective analysis of HNC patients treated over a 6-year period. Patients were divided into 2 groups - those treated between 01/2018 and 12/2020 (pre-OncoSTAT) and those treated between 01/2021 and 12/2023 (post-OncoSTAT). Our institutional HNC database and electronic medical records were queried to determine ER visits, direct admissions, OncoSTAT referrals, treatment related side effects, management, and final disposition from date of RT start up to 8 weeks post-RT.
Results: During RT and up to 8-weeks post-RT, the most common reasons for referral to ER or OncoSTAT clinic were dysphagia, nausea, dehydration, and pain. The number of encounters in the Table exceeds the number of patients as some patients had multiple visits to the ER or OncoSTAT clinic. In the pre-OncoSTAT group, of 392 patients, 156 patients (39.8%) presented to the ER or were directly admitted for in-patient care resulting in a total of 258 discrete encounters. In the post-OncoSTAT group, of the 358 patients, 163 patients (45.5%) were referred to OncoSTAT for a total of 482 encounters of which 434 encounters resulted in discharge to home, 22 transferred to ER of which 10 were admitted, and 26 direct admissions to the hospital resulting in 36 total admissions.
Conclusion: The OncoSTAT clinic was utilized by approximately half of HNC patients receiving RT and 90% of the encounters resulted in patients being discharged to home. This change in practice pattern resulted in 36 in-patient admissions (7.5%) and 12 ER visits (2.6%) as compared to 172 in-patient admissions and 86 ER visits in years prior. The establishment of outpatient oncology urgent care clinic reduced ER visits and admissions for HNC patients undergoing RT.

	Pre-OncoSTAT (2018-2020)	Post-OncoSTAT (2021-2023)
Number of patients treated with RT	392	358
No. of patients presenting to ER, admitted or OncoSTAT	156 (39.8%)	163 (45.5%)
No. of patients presenting to ER, admitted or OncoSTAT receiving concurrent chemotherapy	112 (71.8%)	137 (84.0%)
No. of encounters (ER or direct admissions)	258	--
No. of encounters (OncoSTAT)	--	482
Disposition: Home	n/a	434 (90.0%)
Disposition: ER to Home	86 (33.3%)	12 (2.6%)
Disposition: Inpatient admission (direct or via ER)	172 (66.6%)	36 (7.5%)
Median length of inpatient stay (days)	3.5	3.5