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After-hours Nurse-led Cancer Symptom Management Helps Patients Avoid Emergency Department Visits

Patients with cancer often experience toxicities (negative symptoms or side effects) from the cancer itself and/or treatment. In some instances, the symptoms can be prevented or minimized, which improves the patient’s quality of life and prevents hospitalization and emergency department visits.

In 2016, Ontario Health (Cancer Care Ontario) established a Toxicity Management Advisory Committee to provide guidance on toxicity management for cancer patients in Ontario. The recommendations included ensuring patients have access to remote toxicity and symptom management advice, such as tele-triage, from a knowledgeable provider.

In 2018, we partnered with Bayshore HealthCare Limited to implement CareChart Oncology, an after-hours oncology nursing tele-triage line. Cancer patients and their caregivers can call the phone line on evenings, weekends and holidays when oncology clinics are typically closed. The service connects patients to a specialized oncology nurse who uses evidence-based tele-triage tools, including the pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides.

This service has been successful in benefiting patients, health care providers, and the health care system.

  • Nurses manage most of the calls through patient self-management strategies, with approximately 24% of calls referred to the emergency department.
  • Documentation is sent to the patient’s hospital by end of day to maintain continuity of care.
  • Patient experience surveys revealed more than 90% of patients who completed the survey agreed or strongly agreed that they had a good experience with this service and expressed high satisfaction with the quality of the service.

Since implementation of the service, there has been an estimated 5,211 emergency department visits saved annually, resulting in an estimated annual provincial emergency department cost reduction of $3.8 million. Recent pressures on the health care system are driving the need for innovations in models of care. This initiative highlights the impact oncology nurses can have in prevention and management of treatment toxicities, and the impact patient self-management can have on avoiding visits to emergency departments. This collaboration is unique and shows an important example of well-coordinated patient-centred care.

More information can be found about this initiative in Oncology nursing partnerships shape the future of after-hours toxicity management support.

Last Updated: November 22, 2023