Emergency Department Timeline
- Arrive at the emergency department and check in
- A nurse will ask you questions about your visit. They will obtain your vital signs, ask you about your health history, and current medications
- You will be placed in an exam room. If there is no exam room open, you will be placed in the waiting room. The triage nurse may put in orders for lab work or x-rays while you are waiting
- Once you are in an exam room, a nurse practitioner, physician, or a resident will examine you and order tests to determine what is causing your symptoms or illness. While you wait for your results, one of our nurse case managers may talk with you about any navigation needs you may have
- After your test results are back, the doctor or nurse practitioner will come to discuss them with you. They will determine if you need to come into the hospital or you can go home and follow up with your primary doctor. They will talk with your primary oncology team
- If you need to be admitted to the hospital, you will wait in your emergency department room until you get a bed in the hospital inpatient unit
At the James Comprehensive Cancer Center, we’ve developed an oncology-specific emergency department for our patients with cancer. Since opening the department in 2015, we have discovered the many ways that our patients benefit from this cancer-focused care.
We keep a high level of suspicion in the oncology emergency department when evaluating our patients, investigating for possible cancer progression and considering complications of the cancer and its treatment. We focus on symptom control to ensure the comfort of our patient.
We also get to know our patients through contact with their primary nurse who provides oncology navigation. Oncology primary nurses from our oncology clinics call our emergency nurses directly to relay information about their patient, any specific needs, and any concerns the patient’s primary team may have. This helps to improve our patient assessment and treatment.
Our knowledge of cancer treatments helps to provide correct treatment for patients with cancer. For example, a man with bladder cancer came in complaining of bladder spasms. He had a urinalysis at an urgent care center, which prescribed an antibiotic, because they thought he had an infection. His condition did not improve, and he came to our oncology emergency department; we discovered that he had received treatment with Bacillus Calmette-Guérin (BCG) for the bladder cancer. BCG is injected directly into the bladder, which creates cloudy urine that may look like infection, but rarely is. The patient was overtreated with antibiotics. Based on a urine culture, we changed his treatment, knowing that bladder spasms are often a result of the BCG treatment itself.
Another example is fever associated with chemotherapy, which is a common reason to send patients to the emergency department. Emergency departments without oncology focus may automatically admit these patients to the hospital, even if, overall, they look and feel well. Our contact with the patient’s primary care team allows us to relay lab information, vital signs, and clinical status to the oncologist and allow the oncologist to make the best decisions for the particular patient.
Quick, Accurate Treatment
We are often able to ensure that patients are discharged home quickly (when appropriate) and follow up with their care team in the next few days. This gives patients comfort knowing that their care team is updated on their condition and are involved in the treatment decisions.
We know that when things are off in a patient with cancer, we need to do more than just the basic workup. One patient with renal-cell carcinoma came in complaining of 1-month duration of pain that went from his lower shoulder blade all the way to the middle of his chest. He said it had started after his dog jerked on the leash. He had seen his cardiologist for the pain, who suggested he might have pulled a muscle, or had a small rib fracture. His pain had gotten worse and he had a small lump on the side of his spine. We ordered a CT scan, which showed that the cancer had metastasized into his spine and pushed on the spinal cord, causing the wrapping pain. We discussed this with his primary care team, admitted him to the hospital, and consulted with neurosurgery and radiation oncology. His treatment was started the next day.
There is no routine cancer emergency care. One patient who had cancer 10 years earlier came in complaining of fatigue and night sweats. She was concerned because she felt like the last time she was diagnosed with cancer. She no longer had an oncologist, because she was declared cancer-free, but she wanted someone to listen to her, and do a full workup.
Cancer survivorship starts at diagnosis and lasts the rest of your life. Paying attention to symptoms in cancer-free survivors goes beyond routine care.
In addition, we have access to all clinical trials information online, which helps us to determine the correct treatment plan for patients who participate in clinical trials. Some medications are prohibited while participating in a trial, and we use this knowledge to keep the patients in their trials, which is important, especially when the trial medication is their last treatment option.