Impact of targeted interventions on reducing emergency department visits in breast cancer patients receiving chemotherapy.

433 Background: Breast cancer patients receiving chemotherapy are at increased risk of treatment-related complications prompting emergency department (ED) visits. OP-35 is an MD Anderson institutional quality measure aimed at reducing unplanned ED visits within 30 days of outpatient chemotherapy. This project, led by the Breast Medical Oncology Quality Improvement Team aimed to reduce return rates of breast cancer patients at MD Anderson undergoing chemotherapy to the Acute Care Cancer Center (ACCC), MD Anderson’s oncology dedicated ED. Prior analysis identified opportunities to reduce ACCC presentations and targeted interventions were implemented: a comprehensive triage guide for staff, patient education encouraging contact with the care team prior to ED presentation, and a pilot self-referral pathway to the Urgent Symptom Clinic (USC). A retrospective analysis was conducted to evaluate the impact on ACCC return rates. Methods: A retrospective study was performed on breast cancer patients receiving chemotherapy who presented to the ACCC during August 2024, pre-intervention, and April 2025, post-intervention. August 2024 was selected based on available data used prior to inform intervention design, and April 2025 reflected the most recent complete post-intervention data. Data collected included patient demographics, time since last chemotherapy, reason for ACCC visit, and referral source. Visits without documentation of prior provider contact were categorized as self-referrals. The 30-day return rate was defined as the proportion of patients presenting to the ACCC within 30 days of chemotherapy administration. Results: In the pre-intervention month, there were 60 return visits to the ACCC within 30 days of chemotherapy, compared to 41 visits in the post-intervention month. Median age was 55 years pre-intervention vs 48 years post-intervention. Median time from most recent chemotherapy to ACCC presentation was similar, 10 days pre-intervention vs 9 days post-intervention. The 30-day return rate decreased from 14.2% pre-intervention to 9.7% post intervention (p = 0.046, Chi-square test). Additionally, the rate of self-referrals to the ACCC without prior care team contact decreased from 48% pre intervention to 41% post intervention. Conclusions: Implementation of these targeted interventions to improve triage pathways, direct appropriate patients to USC, and improve contact with care team prior ACCC visits were associated with a significant reduction in 30-day ED return rates and a decrease in ACCC self-referral rates among breast cancer patients undergoing chemotherapy. Continued evaluation is needed to assess sustainability with the long-term goal of implementing OP-35 to reduce ED burden, optimize resources, and enhance care delivery in the appropriate clinical setting.