LAUSR

302 Background: At our academic medical center, acute on chronic pain, gastrointestinal symptoms and fever led to most preventable ED visits and hospitalizations amongst cancer patients on chemotherapy. We developed management pathways to target these symptoms. Methods: Existing symptom management algorithms and internal expert consensus of multidisciplinary stakeholders, including palliative care and infectious disease, contributed to initial symptom management algorithms. After iterative revisions, the pathways were finalized by hematology/oncology physician and nursing leadership. We identified outpatient, non-oral, cancer directed treatment events using pharmacy billing data. These events included traditional chemotherapy, immunotherapy, and hormonal therapy. We then identified any ED visit or hospitalization at our medical center within 30 days of the event. We plan a pre-post analysis to determine change in 30-day ED visits and hospitalizations for any reason and for our target symptoms. Results: We developed pathways for acute on chronic pain, nausea/vomiting, diarrhea, constipation, and fever. Each pathway follows a standardized model including warning signs with guidance on direct referral to the ED or urgent clinic referral, the specific treatment algorithm, and helpful references. The pathways were implemented in May 2018. From January 2016 to February 2018, we identified 28,764 treatment events among 4,197 patients. Patient mean age was 63 years. The most commonly used treatments were fluorouracil, leuprolide, and paclitaxel. Within 30 days, 5.7% had an associated ED visit; 5.0% had any hospitalization. Conclusions: We developed management pathways for common symptoms among patients receiving cancer treatment. Generalizing care for such a heterogeneous population can be challenging and requires significant engagement from a multidisciplinary team. Post-intervention data is forthcoming to assess the impact of the pathways on reducing ED visits and hospitalizations.