Consultant Led Symptom and Urgent Review Clinic (SURC) – Innovative, Unique & High Quality Cancer Care

From the 2023 HVPA National Conference

Vikas Wadhwa MBBS (Peter MacCallum Cancer Centre), Sandra Day RN, Jayne Watson RN, Mpilwenhle Mthunzi PhD

Background:
Peter MacCallum Cancer Centre (Peter Mac) is a leading cancer care and research institution in Melbourne, Australia. Patient care is supported by tumour stream specific clinical nurse consultants, patient navigators, and medical teams. In response to the Covid pandemic, a consultant led SURC model of care was established in September 2021. All other SURC models in Victoria are currently nurse led and manage calls directly from patients. Peter Mac SURC has proven to be effective in improving access to immediate and high-quality care for patients with cancer whose clinical complexity and symptom acuity would have otherwise required emergency department (ED) presentation and /or hospital admission.

Objectives:
SURC at Peter Mac was established with the aim of providing urgent care for patients with moderate to severe symptoms related to their cancer diagnosis or treatment and who were unable to be treated at home or in an alternate outpatient setting. Patients were referred  by tumour stream clinical nurse consultants or medical staff where other options of community or outpatient based care were considered unsuitable. Expected benefits were reductions in unplanned ED presentations and hospital admissions, improved outcomes and enhanced patient experience. Reductions in overall healthcare costs through reduced length of stay were also considered potential outcomes.

Methods / Description:
A 2 chair model was established that operated weekdays 0830-1800 hours and led by a medical consultant. SURC was co-located within the existing Chemotherapy Day Unit and supported by unit nursing staff . Decision making and treatments provided to patients were part of a care continuum with constant communication with and support by home teams. Funding was subsequently secured that enabled the appointment of a dedicated SURC Clinical Nurse Consultant which has provided joint leadership, greater operational stability, an increased ability to meet growing SURC demands and integration of virtual care. The model is being considered for expansion to 4 chairs with extended timings.

Results:
Despite limited chair capacity, SURC referrals have rapidly increased (Picture 0). Even with high complexity and acuity in presentation, the majority of patients have been seen face to face promptly with almost 55% able to be discharged after assessment and intensive management. Approximately 40% have required an admission to hospital after SURC intervention and transfers to ED minimised (Picture 1). Presenting complaints have been variable and have included febrile neutropenia, sepsis, bowel obstruction, chemotherapy and immunotherapy related adverse-events and organ dysfunction. Treatments provided in SURC have included intravenous fluids, antibiotics, blood products and interventional procedures.

In addition, with SURC being predominantly consultant led, invaluable clinical support, and education to referring nurse consultants and junior medical staff have been further benefits that have been realised. Pre-booking for the next day where appropriate and virtual care have been alternatives when suitable patients have been unable to be accepted immediately for face-to-face review, due to chair capacity constraints. Enhanced efficiency and prioritisation of SURC for laboratory and radiological investigations has effectively increased chair turnover and capacity even further, however limitations to service expansion remain in access to inpatient beds, space, and nursing staff. Patient experience has however been overwhelmingly extremely positive.

Conclusions:
A unique and innovative consultant led SURC model of care has been extremely successful in delivering urgent patient centred care and reducing hospital admissions in those with moderate to severe symptoms related to their cancer diagnosis and/or treatment.

 

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

Learn more about HVPA on Health Affairs Blog