For oncology patients, the emergency department is often the wrong place at the wrong time. Crowded waiting rooms, infection risks, and nonspecialized triage can turn manageable treatment complications into hospital admissions. That’s why institutions like Johns Hopkins Hospital are redefining access to urgent care: offering cancer-specific alternatives that keep patients safe, out of the emergency department, and connected to their oncology teams.
At Johns Hopkins, this model is known as the Oncology Evaluation and Treatment Center (OETC), a 24/7 urgent care site designed for same-day evaluation and management of acute oncologic conditions. The program was developed under the leadership of Donna Berizzi, DNP, RN, OCN, who shared its evolution and outcomes at the 2025 Oncology Nursing Society Bridge Conference.
“Our patients want to receive care from individuals with oncology experience,” Dr Berizzi said. “They do not want, nor should they have to go, to an emergency room for issues that arise from cancer treatment.”
Why the Emergency Department Isn’t the Best Fit
General emergency departments are built to stabilize acute, undifferentiated illness. However, that model doesn’t always serve patients whose complications stem from chemotherapy, immunotherapy, or other cancer treatments. Dr Berizzi noted that “minutes matter” for these patients, and specialized oncology assessment can change outcomes.
“Emergency departments are wonderful for acute medical emergencies,” she said, “but they aren’t equipped to manage the nuances of oncology care. Our patients often don’t appear as ill as they are, and they can deteriorate quickly.”
She outlined several challenges of emergency department–based care for oncology populations:
- Infection control: Immunocompromised patients face heightened risk in crowded waiting rooms
- Delays in triage: Because cancer-related symptoms may not look severe, patients are often deprioritized
- Limited oncology expertise: Clinicians may not recognize treatment-specific toxicities or complications
The result, she said, is “suboptimal management—not because the emergency department doesn’t want to provide good care, but because they may not understand the complexity of these patients.”
The Case for Oncology Urgent Care
The OETC was built to bridge this gap by providing specialized, immediate care in a dedicated oncology space. Its mission, Dr Berizzi explained, is to deliver same-day diagnosis, treatment, and symptom management for patients with acute oncologic conditions by experienced, compassionate oncology clinicians.
The OETC is staffed by oncology-trained nurses and advanced practice providers (APPs) who manage a broad spectrum of concerns—from fever and dehydration to chemotherapy toxicity, vascular access issues, and suspected thrombosis. Practicing at the top of their scope, these clinicians understand each patient’s treatment plan within Epic, collaborate with the longitudinal oncologist, and make decisions aligned with the individual’s therapy trajectory. That level of specialization allows for timely interventions, early recognition of complications, and true continuity of care.
“We stabilize symptoms, prevent further decline, and support ambulatory status,” she said. “It’s about the right patient in the right environment, receiving the highest-quality care at the lowest cost.”
Building the Model
When designing an oncology urgent care program, Dr Berizzi emphasized the importance of defining a clear mission, securing buy-in, and tailoring services to institutional capacity.
She recommended starting with a tiered model for staffing and hours of operation. “Even though the uptick in patients may be slow at first, if you build it, they will come,” she said.
At Johns Hopkins, the OETC began as an 11 pm-to-close model but expanded rapidly as demand grew. “During the COVID Omicron surge, we went to a 24/7 model because our patients needed to stay out of the hospital,” she recalled. “We had to flip that in 24 hours, and within a week, we were rolling.”
The outcomes speak for themselves: roughly 75% of patients treated in the OETC are discharged home, while only 15% to 20% require inpatient admission, and about 5% are transferred to the emergency department.
“That’s the value right there,” Dr Berizzi said. “Patients get specialized care and sleep in their own bed that night.”
Partnership and Return on Investment
For health systems, oncology urgent care also eases the strain on inpatient units and emergency departments. “We are helping our mergency department partners by decanting that area,” Dr Berizzi noted. “Fewer emergency department visits mean fewer hallway patients and faster throughput for everyone.”
She underscored that every urgent care proposal must be tailored to its audience, as finance, operations, and clinical leadership departments each measure success differently. “When you’re setting up new services, you have to know your audience and tell the story,” she said. “Finance will want to understand the return on investment; clinicians will care about the outcomes.”
Even so, she added, “For oncology nurses, if we keep 1 patient out of the emergency department, that’s an adequate return on investment.”
A Sustainable Future
Dr Berizzi encouraged institutions to view specialized oncology urgent care not as a luxury but as a necessary evolution in cancer care delivery. Ambulatory models are expanding, treatments are more complex, and patients are increasingly empowered to expect expert, accessible care.
“Our commitment to maintain rapid access to specialized care has to remain constant,” she said. “At the core of what we do is providing the right care for the right patient in the right setting, at the right cost. And no one does that better than oncology nurses and oncology APPs.”