By Merin C. MacDonald
Chemotherapy desensitization procedures at UMass have historically been done in the ICU, but when an ICU bed is used for the procedure, it requires a reservation and the use of the bed for at least 24 hours.
With a rapidly growing number of chemotherapy allergy patients being referred to UMass, Geneva Mehta, MD, an assistant professor of medicine in the Division of Pulmonary, Allergy, and Critical Care, conducted a review of chemotherapy desensitization procedures done at UMass over the last several years and compared her findings to published reports. She found that for a large majority of patients, desensitization procedures are low-risk and do not require ICU admission. Thus, she developed criteria to determine patient risk. Although some of the highest-risk patients will still need to go to the ICU to be desensitized, most can now have this done in the ACC infusion area where they usually have their chemotherapy or, in some intermediate-risk cases, on an inpatient medicine floor.
For oncology patients, this new initiative will prevent delays in therapy associated with waiting for ICU bed availability, and enable them to have the procedure done in a more comfortable and convenient location. Visits can now be scheduled in advance, along with the patient’s usual treatments, and they will not have to endure the stress of waiting for a call into the ICU, which previously may have come in the middle of the night and with short notice. This is also greatly beneficial to the hospital system as it alleviates unnecessary usage of already scarce ICU beds.
Dr. Mehta established this new protocol with assistance from and collaboration with Stephen Krinzman, MD, associate professor of medicine, also in the Division of Pulmonary, Allergy, and Critical Care, as well as representatives and leadership from Allergy/Immunology, Oncology, Pharmacy, Quality Improvement, Hospital Medicine, and Nursing.
“Every time we can avoid using an ICU bed for these procedures, it makes that bed available to an unstable, critically ill patient who would otherwise be waiting in the ED or a hospital floor bed,” said Dr. Krinzman.