Expansion of Acute Oncology Services at an Acute Tertiary Care Trust without inpatients oncology beds

Abstract

The Acute Oncology Service (AOS) has utilised the acute medical team in the provision of cancer care at the front door as well as setting up a malignancy of Unknown Origin (MUO) service and a Same Day Emergency Care (SDEC) pathway. This has been achieved by recruitment of an acute medical consultant as an AOS lead and a review and restructure of the nursing workforce. This has resulted in an increase in AOS Clinical Nurse Specialists (CNS) and Advanced Clinical Practitioners (ACP) to support local care and facilitate ward rounds with visiting oncology consultants from cancer centre.

Expansion of AOS service has allowed to improve documentation and communication to parent oncology teams. Early discharge and reduction in length of stay for patient on MUO pathway from March 2024 to June 2024. That allowed the AOS-specific SDEC pathway from March 2024. The AOS project group was set-up with main stakeholder Emergency Department (ED) and Acute Medicine (AM) and met every 2 weeks. The aims of the project were: A) To establish a new 7-day referral service with ED B) Agree working Standard Operating Procedure with Acute Medicine and AOS C) Agree patient identification criteria for ambulatory care assessment at ED D) Assess patients' experience.

A substantial majority of cancer patients delayed reporting symptoms for more than three days. Despite the relatively low number of oncology patients attending the Emergency Department (ED), a significant proportion required inpatient admission. Furthermore, findings indicate that these patients often present in a more acutely unwell state, highlighting the need for encouraging patients to seek early advice to prevent symptom exacerbation and facilitate referral to alternative assessment pathways outside of the ED. Reinforcing the use of the Acute Oncology Service (AOS) alert card is recommended to expedite assessments and treatment processes.