title: A Rapid Access Clinic to improve delivery of ambulatory care to cancer patients.
abstract: BACKGROUND
  Cancer patients may find it challenging to access timely advice and care. We evaluated the improvement in delivering ambulatory care in establishing a Rapid Assessment Clinic (RAC) in a cancer center.
  
  
  METHODS
  Patients receiving chemotherapy who presented for assessment at the RAC from September 2013 to June 2014 were included for review. Patient demographics, tumor characteristics, presenting complaints, time to assessment, total time spent at the RAC and assessment outcome were extracted. Similar data for cancer patients presented to the emergency department (ED) but were appropriate for RAC assessment from February 2012 to August 2012 were reviewed for comparison. For patients with febrile neutropenia, time to empirical antibiotic therapy was also reviewed and analyzed.
  
  
  RESULTS
  Comparing to ED presentation (n = 152), patients reviewed at the RAC (n = 217) had a shorter waiting time to medical review (28.5 vs 40 min, P = 0.12), shorter total time spent for review (3.1 vs 9.7 hrs, P < 0.001), lesser rate of hospital admission (14.3% vs 69.1%, P < 0.001) and shorter inpatient length of stay (4 vs 7 days, P = 0.013). Presentations of febrile neutropenia were reviewed more promptly in ED (6 vs 9.5 min, P = 0.37), but this did not result in earlier empirical antibiotic administration (79 vs 74 min, P = 0.84).
  
  
  CONCLUSIONS
  Comparing to ED, RAC had improved timeliness of care, resulting in a lower rate of hospital admission and inpatient length of stay for cancer patients. There was, however, no difference in the management of febrile neutropenia.
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Garran, Australian Capital Territory, Australia.
authors.forename: James C
authors.initials: JC
authors.lastname: Kuo
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Garran, Australian Capital Territory, Australia.
authors.forename: Madhawa
authors.initials: M
authors.lastname: De Silva
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Garran, Australian Capital Territory, Australia.|Department of Cancer Biology and Therapeutics, John Curtin School of Medical Research, Australia.
authors.forename: Chandra
authors.initials: C
authors.lastname: Diwakarla
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Garran, Australian Capital Territory, Australia.|ANU Medical School, Australian National University, Acton, Australian Capital Territory, Australia.
authors.forename: Desmond
authors.initials: D
authors.lastname: Yip
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies
keywords: access to health care; ambulatory care; febrile neutropenia; hospital care; medical oncology; quality improvement