Fred Hutch expands nurse navigation, ACE clinic

Goals of nurse navigation and new Montlake acute care clinic: improved patient experience, reduced emergency visits
The ACE Clinic at South Lake Union with the staff
A new Acute Clinical Evaluation clinic has opened at UW Medical Center - Montlake, offering cancer patients another option for having severe symptoms evaluated and treated outside of the emergency room. The Nurse Navigation program has also been expanded to better serve patients. Fred Hutch file photo

Spring has sprung at Fred Hutchinson Cancer Center with a brand-new clinic building and proven patient programs blossoming right alongside the crocuses and daffodils.

In addition to a new “sister” clinic building on the South Lake Union campus, Fred Hutch has expanded two other programs to better help patients navigate cancer treatment.

One is designed to work directly with newly diagnosed patients to coordinate all the necessary appointments, scans and tests required before starting their first line of treatment. The other will help those who are experiencing symptoms and side effects of either their cancer or their cancer treatment in order to keep them from having to go to the emergency room.

Navigating patients through care

Getting a cancer diagnosis can be overwhelming. Rattled patients may not remember the name of their doctor or even understand the kind of treatment they need for their cancer.

That’s where nurse navigators come in.

“When patients are first diagnosed, they’ll now talk to a nurse navigator immediately,” said Janelle Wagner, RN, director of the program. “The nurse will go over the diagnosis in full detail and provide education. They’ll also talk about probable next steps and help coordinate the diagnostic procedures, placing orders and helping with scheduling.”

Nurse navigators help to streamline the process, she said, making sure patients receive all necessary testing and connect with the proper clinicians.

Navigators will also conduct psychosocial screening, ask about family history and identify barriers to care — transportation issues, socioeconomic concerns, etc. — connecting patients with services that will allow them to complete their treatment. Nurse navigators will also connect patients to supportive care, dieticians, genetic testing and clinical trials.

“The goal is to get patients to their first line of treatment faster,” Wagner said.

An oncology nurse for over 20 years, Wagner said most delays happen between diagnosis and the first line of therapy “regardless of whether it’s metastatic disease or early-stage disease.”

“That’s the biggest gap. That’s also when patients are under the most stress, when they don’t have their care team yet,” she said, explaining that some patients who receive a cancer diagnosis don’t actually return for any treatment.

“We don’t know if they get care elsewhere or just don’t get care at all,” she said. “But with nurse navigation, we retain about 95% of all patients diagnosed.”

And the patients are much more prepared for their first appointment.

In studies, Wagner said nurse navigation cut the median time from diagnosis to therapy from 42 days down to 28 days (guidelines recommend cancer treatment start within 30 days of diagnosis). The program has also been helpful in eliminating disparities in care.

For now, the program is still in expansion mode with nurse navigation offered at the South Lake Union (SLU) clinic, and at Fred Hutch clinics at Overlake Cancer Center, UW Medical Center - Northwest and Peninsula.

Eventually, Fred Hutch is aiming to have 31 navigators available to help patients.

Fred Hutch's ACE clinic Associate Director Jeannine Sanford (left) and Director of Nursing Timothy Ehling (center) said the clinics have been popular with both patients and oncologists. Janelle Wagner (right) is the director of the nurse navigation program, which also recently expanded.
Fred Hutch's ACE clinic Associate Director Jeannine Sanford (top) and Director of Nursing Timothy Ehling (center) said the clinics have been popular with both patients and oncologists. Janelle Wagner (bottom) is the director of the nurse navigation program, which also recently expanded.

Fred Hutch file photos

New ACE clinic opens at Montlake

Fred Hutch also opened a new referral-only ACE, or Acute Clinical Evaluation, clinic at UW Medical Center - Montlake, which along with the current Fred Hutch SLU clinic, effectively doubles the capacity for acute patient care.

“There are three beds in SLU, which has been open for three years now, and three at Montlake with the potential to go to six,” said Director of Nursing Timothy Ehling, MN, RN. “In the future, we’ll have nine spaces for patients to go.”

ACE clinics enable Fred Hutch cancer patients to access care in a timely manner for any acute (severe) symptoms. 

“These clinics provide acute evaluation for patients experiencing side effects or symptoms from their cancer diagnosis or from the cancer treatment they’re receiving,” said ACE Clinic associate director Jeannine Sanford, ARNP, OCN. “The goal is to decrease unnecessary emergency department utilization.”

Sanford said the ACE clinics are staffed by nurse practitioners, physician assistants and nurses, all trained to help patients with issues caused by cancer treatments.

“We can easily address fever, infection, nausea and vomiting, shortness of breath, dehydration, constipation and diarrhea, lab abnormalities and much more,” she said. “We can also make referrals to palliative care supportive services or specialty clinics as needed.”

Procedures such as paracentesis (draining a buildup of ascites fluid in the abdomen) or thoracentesis (draining fluid buildup in the lining of the lungs) are not performed at the ACE clinics. However, Sanford said they are planning to offer this service in the future.

Additionally, major health issues such as severe bleeding, acute chest pain or severe respiratory distress will not be handled at the ACE clinic but referred on to an emergency department.

Sanford said the ACE Clinic does not accept walk-in appointments or self-referrals, but patients can easily be referred by their oncology teams.

“Patients are absolutely encouraged to ask their providers for a referral,” she said.

Currently, about a quarter of ACE patients are already on site at the SLU clinic when referred.

“An example is someone who spikes a fever,” Ehling said. “They’ll come in for an appointment and will need care, but the clinic may not have the staffing or capacity to keep the patient. They can then be referred to the ACE clinic.”

If patients experience acute issues such as breakthrough nausea or respiratory issues while at home, they’re encouraged to call their oncology team right away, either via the regular number or the after-hours line which will connect them to an on-call physician.

Ehling said a live person will take the call, talk to the patient, then decide where they should get care.

“Sometimes, the advice is ‘Come to the ER and I’ll see you there.’ Sometimes, it’s ‘I’ll arrange for you to be seen in the ACE clinic,’” he said. Providers will determine which ACE clinic the patient should go to, depending on capacity, time of day and other factors.

So far, Sanford said the clinic has proven popular.

“We have heard overwhelmingly positive reviews from patients and providers,” she said. “The mission behind these clinics is well supported.”

Diane Mapes is a staff writer at Fred Hutchinson Cancer Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she blogs at and tweets @double_whammied. Email her at Just diagnosed and need information and resources? 

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