An implementation study was conducted to examine a newly established Symptom and Urgent Review Clinic (SURC) for patients experiencing toxicities related to systemic anti-cancer therapy (SACT) delivered within the ambulatory setting. This nurse led model of care aimed to improve management of SACT toxicities, decrease unplanned presentations to emergency department (ED) and unplanned admissions for SACT related toxicity and decrease treatment delays on day of treatment due to sub-optimal toxicity management.
An economic assessment was undertaken to estimate the costs of SURC from the service funder perspective and to compare the cost with cost offsets from the implementation of the model. Cost offsets focused on the changes in emergency department (ED) presentations and inpatient (IP) admissions during a comparable 6 month period before and post SURC implementation.
A total of 915 clinic episodes were delivered at the Austin Health SURC service between 1 March – 31 August 2018 including phone consultations (n=526; 58%), in person attendances (n=220, 24%) and patient education sessions (n=169; 18%). A total of 25 (2.7%) episodes required IP admission. After clinic implementation patients were less likely to present to the ED (7.2% v 8.5%; P=0.1) and patients who did present to ED were more likely to be admitted to inpatient units. (78% v 71%; P=0.3). There was a net cost saving of $37,090 in real 2018 values. SURC achieved an investment return of $1.73.
SURC delivers targeted, rapid access to specialist advice for oncology patients treated in the ambulatory setting. This model demonstrates an efficient approach for hospital resource allocation to deliver quality cancer care.