Improving cancer care efficiency in Covid-19 recovery: A service improvement project establishing an Emergency Ambulatory Acute Oncology Service


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Charlotte Maden1, Alison Hodge2, David Bloomfield2
1University Hospitals Sussex, 2Brighton and Sussex University Hospitals NHS Trust

Abstract

Background

Patients with cancer should have access to an Acute Oncology (AO) service offering specialist review within 24 hours of referral.1,2 They currently attend the Emergency Department (ED) in a south of England tertiary centre. The trust has a high cancer inpatient burden (20%), with 52% of these patients experiencing cancer-related symptoms.Presently, the trust has a nurse-led Acute Oncology team and an inpatient-based Clinical Oncology team. Streaming an integrated AO service through the established Emergency Ambulatory Care unit (EACU), could improve patient satisfaction and care efficiency, and decrease emergency admissions in the Covid-19 recovery period.4-8 

Method

PubMed/Ovid were searched for ‘Acute Oncology Service’ and expanded terms (inception-May 2021). Trust guidelines were reviewed, and MDT discussions and fishbone/DMAIC root cause analysis undertaken. A prospective 6-point questionnaire with paired pathway data (time from arrival to review, treatment and discharge etc.) explored current patient satisfaction and care efficiency. Inclusion criteria were all adult known-cancer patients without significant cognitive impairment, accepted by AO (9am-5pm, 30/04-14/05, n=22). Audit of referrals to AO during this period and existing EACU oncology attendances (01/04-14/05) identified workload. EACU patient pathways and a discharge summary template were created.

Results

On average, Acute Oncology nurses accept 2.4 patients/day. They review 3 patients/week on an ad hoc basis in EACU, which does not currently have a formal AO review pathway. Time to AO referral and review from arrival were 21.5 and 69.5 hours respectively. Time to definitive oncology treatment was 3.7 days. 13/22 patients were ‘very satisfied’ with their experience. Those that were not expressed long waits for investigations/reviews and minimal communication. 72% of patient respondents would like an Emergency Ambulatory Acute Oncology Service.

Conclusion

Time to AO review from referral is currently twice the recommended length. Inefficient pathways cause dissatisfaction for cancer patients and staff who both favour EACU AO pathways. EACU infrastructure and current staffing levels can support the transition. A new AO EACU streaming service will minimise the discrepancy and lack of clarity of care pathways for oncology patients. Post-embedment, re-audit of satisfaction and efficiency is required.

Impact statement

Improvement of patient cancer care efficiency and alleviation of ED pressures in Covid-19 recovery.