Implementation of an Acute oncology service  –  a UK teaching hospital experience


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Judith Carser1,2, Michael Varey2, Susan O'Reilly1,2, David Smith1,2, Diane Wong1
1Clatterbridge Centre for Oncology NHS Foundation Trust, Wirral, Merseyside, UK, 2Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, Merseyside, UK

Background

The acute oncologyservice at the Royal Liverpool University Hospital was established in 2010 to provide specialist oncologyadvice forcancer patients presenting as an emergency following recommendations by the National Chemotherapy Advisory Group. The service includes support for patients presenting with a previously undiagnosed cancer, those with complications of therapy and those with complications from a previously diagnosed malignancy.

Method

We conducted a prospective review of all patients referred to the acute oncology service within the first 6 months of implementation between September 2010 and March 2011 to assess impact of the service upon length of hospital stay (LOS).

Results

From September 2010 – March 2011, 271 patients had been referred with a total average LOS of 9.6 days. New presentations of cancer accounted for 24%, complications of chemo/radiotherapy 33% and complications from a previously diagnosed cancer comprised 42% of referrals.  A steady increase was observed in referrals of patients with carcinoma of unknown primary origin (CUP). The average LOS for all patients has fallen steadily since implementation from 15 days in September to 10 days in March. The largest decrease in LOS is amongst patients presenting with a new cancer diagnosis (27 days September 2010 to 9 days March 2011).

Conclusion

The acute oncology service has clinical and financial benefits for patients and staff working within our hospital trust by reducing the duration of hospital admission as well as avoiding unnecessary investigations and improving access to specialist oncology support. We are enhancing this service by developing a rapid access outpatient clinic for patients with a provisional diagnosis of CUP.