Right care, right place: Penn Cancer Cavalry, a home-based urgent care model for oncology patients.

420 Background: For patients with cancer, time at home is precious. Unnecessary emergency department (ED) and urgent care visits frustrate patients, especially those near the end of life, and contribute to health system inefficiencies. In FY22, our 30-day unplanned readmission rate was 18.35%, ranking 26 of 108 academic medical centers (Vizient). Oncology units operated at 98% capacity, with a median ED wait time of 8.5 hours for an inpatient bed. Against this backdrop at our large academic health system, we posed a critical question: How can we safely meet cancer patients where they are—at home?. Methods: In June 2023, an interdisciplinary team of stakeholders across the cancer care continuum (inpatient, outpatient, ED, and home care) launched a proof-of-concept pilot using a Mobile Integrated Healthcare (MIH) model to deliver rapid symptom management at home. Through the MIH model, the “Cancer Cavalry” team rapidly deployed RNs who visited patients at home with the goal of assessment and stabilization in the home setting. Patients were referred by their primary oncology teams and the homecare RNs provided care under the direction of physicians and advanced practice providers. Stakeholders from across the cancer care continuum collaborated to identify patients whose symptoms could be safely managed at home. Analysis revealed that 18% of oncology urgent care visits and 13% of short-stay readmissions (mostly through the ED) involved symptoms like nausea, vomiting, diarrhea, and dehydration. By treating these at home with IV fluids and antiemetics, we aimed to reduce avoidable facility-based visits. The model evolved through real-time learning—modifying supply bags, expanding services to include lab specimen collection and IV antibiotics, and adapting workflows to better meet patient needs. Results: The pilot included 72 unique patients and 91 home visits, with an average nurse response time of 1.8 hours, visit duration of 1.7 hours, and 2.0 hours to lab result availability. Only three visits required 911 escalation. Within seven days post-visit, 98% of patients avoided related ED visits or admissions. Patient and caregiver interviews revealed overwhelmingly positive feedback. The intervention was safe, effective, and highly valued, offering patients care at home and reducing health system strain. Next steps include expanding hours, locations, and eligible conditions. Conclusions: The “Cancer Cavalry” offers a novel, scalable solution for timely symptom management at home. Its success reflects thoughtful population segmentation, interdisciplinary collaboration, and an innovative approach to referral and triage.