By Mary Jo Feldstein, St. Louis Post-Dispatch, September 24, 2008

The Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine will begin offering urgent care to its patients at any time of day, any day of the week. Siteman is scheduled to open the new urgent care center by March at Barnes-Jewish''s north campus.

The center will be one of only a handful in the nation. Its sponsors hope to prevent fragile cancer patients from having to wait for hours in a general emergency room.

Dehydration, anemia and other complications from cancer and its treatments frequently send patients to emergency rooms. But those trips often don''t go smoothly.

"Patients are frequently very frightened," said Mary Scott, a nurse who is Siteman''s director of oncology services. "They don''t know if what they''re experiencing is normal or not."

Patients'' compromised immune systems can be exposed to other illnesses during the long waits. When patients are seen, the emergency room physicians not familiar with their cancer or treatments must make decisions quickly.

With the new urgent care center, these patients — who most often need fluids or infusion — can be treated quickly and by specially trained medical staff. Nurse practitioners familiar with cancer treatments and Siteman''s clinical trials will work with Washington University hospitalists to staff the clinic.

Siteman identified the need for the clinic after examining patient records at Barnes-Jewish and Siteman. About 20 Siteman patients a day are treated and released from the emergency room at Barnes-Jewish. Another four are admitted to the hospital through the emergency room.

The urgent care center also expects to draw Siteman patients who would have gone to the emergency rooms of other local community hospitals.

At the start, the center expects to treat about 30 patients a day. About half of these patients will be unscheduled visits. The rest will be scheduled treatments for patients needing more flexible scheduling because of family or work responsibilities. This will provide a steady patient flow to help offset the nearly $1 million cost of the clinic.

"You have to have a critical mass (of patients) to make this work," said Amy Determann, a registered nurse and the director of the center.

Siteman patients arriving without an appointment will be asked to call their oncologist first to receive a referral.

The center will include seven infusion chairs, three treatment rooms and one negative-pressure room. Siteman''s weekend bone marrow transplant clinic also will relocate to the center.

Cancer patients not regularly seen by Siteman physicians or Siteman patients with emergency needs unrelated to their disease, such as a heart attack or stroke, still will need to visit a traditional emergency room.

Memorial Sloan-Kettering Cancer Center in New York was one of the first in the nation to create an urgent care center for cancer patients. It now sees about 20,000 patients a year.

Dr. Jeffrey S. Groeger, chief of urgent care service at Sloan-Kettering, said the expertise of the center''s physicians helps keep patients from needing to be admitted. The center also has immediate access to the patients'' medical records. "We''re familiar with the complications and know what to look for," Groeger said.