Building on the 3 pillars of acute oncology: A snapshot audit 3 years on


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Adam Fullagar1, Antonia Creak1, Sarah Westwell1, Juliet Brock1
1Brighton and Sussex University Hospitals NHS Trust, Sussex, UK

Background

The remit of an Acute Oncology service (AOS) is to manage patients presenting with complications of cancer, complications of cancer treatment and acute admissions caused by undiagnosed cancer (the three pillars). The impact of an AOS has been assessed by auditing all inpatients in one hospital with a cancer diagnosis on one day.

Method

Systematic ward review identified patients with known or suspected cancer on the 13/12/12 at 09:00. Length of stay (LOS), outcome and time to AO referral were recorded. Relevant notes were reviewed. Results were compared with a snapshot audit undertaken before introduction of the AOS, and AO data regarding LOS.

Results

48 patients had a known or suspected cancer diagnosis (8% of inpatients). Average LOS was 19 days (median 12). The longest admissions were for complications of cancer and investigation of suspected malignancy (25 and 27 days respectively). Patients with suspected malignancy deemed unfit for investigation (4/10, 40%) were referred late to AO (average 26 days from admission). All patients with complications of treatment were referred within 48 hours (average LOS 19 days).

In the Pre-AOS data 19% of all inpatients had known or suspected cancer. 21 were admitted with suspected malignancy, of whom only 3 (14%) were deemed unfit for investigation by their team. Average LOS for all cancer patients was 11 days. Other local AO data showed average LOS reduced by approximately 6 days after the introduction of the AOS.

Conclusion

AOS impact is difficult to assess from this audit. Data includes inpatients with multiple co-morbidities requiring admissions of over 100 days.

Frail patients with suspected cancer are referred late to the AOS. More work on service promotion and educating hospital teams is required.

When AO is involved, appropriate decisions can be made to stop further investigation, refer to palliative care and expedite discharge.