Prospective cohort study of an Australian cancer care services-led model of emergent care
Elise Button A B C F , Nicole C. Gavin A B , Tracey Bates A , Deka Ahmed D , Gillian Nasato A , David Wyld A B E , Glen Kennedy A E , Eileen Fennelly A , Michael Smith A , Sarah Northfield A and Patsy Yates A B CA Cancer Care Services, Level 2, Block 34, Royal Brisbane and Women’s Hospital, Bowen Bridge Road, Herston, Qld 4006, Australia. Email: nicole.gavin@health.qld.gov.au; tracey.bates@health.qld.gov.au; gillian.nasato@health.qld.gov.au; david.wyld@health.qld.gov.au; glen.kennedy@health.qld.gov.au; eileen.fennelly@health.qld.gov.au; michael.smith2@health.qld.gov.au; sarah.northfield@health.qld.gov.au
B School of Nursing, Queensland University of Technology, 149 Kelvin Grove Road, Kelvin Grove, Qld 4059, Australia. Email: p.yates@qut.edu.au
C Centre for Healthcare Transformation, Queensland University of Technology, 149 Kelvin Grove Road, Kelvin Grove, Qld 4059, Australia.
D Mater Hospital Mater Health, Raymond Terrace, Woolloongabba, Qld 4102, Australia. Email: deka.ahmed@connect.qut.edu.au
E School of Medicine, University of Queensland, 288 Herston Road, Herston, Qld 4006, Australia.
F Corresponding author. Email: elise.button@health.qld.gov.au
Australian Health Review 45(5) 613-621 https://doi.org/10.1071/AH20346
Submitted: 4 December 2020 Accepted: 25 March 2021 Published: 13 July 2021
Journal Compilation © AHHA 2021 Open Access CC BY-NC-ND
Abstract
Objective Many cancer care services (CCS) provide pragmatic models of emergent care for their patients as part of ‘business as usual’ without understanding the scope of this work. We aimed to describe an Australian CCS-led model of emergent care and quantify and profile emergent care provided over a 6-month period to understand scope and demand.
Methods This prospective cohort study was performed at a large tertiary hospital on the eastern coast of Australia in 2016. The study explored emergent care provided during business hour and after-hours, including telephone advice, unplanned care and unplanned admissions. Data were collected via electronic hospital records and clinical nurses regarding who accessed care, why care was accessed, what care was provided and how the episode of care ended.
Results Between March and September 2016, 1412 episodes of unplanned care were provided in the CCS-led model of care, including 307 episodes of telephone advice (237 patients; min max 1–4 episodes per patient; 825 episodes of unplanned care (484 patients; min max 1–9 episodes per patient) and 280 unplanned admissions (233 patients; min max 1–6 episodes per patient). During the same time, an additional 459 unplanned admissions (361 patients) occurred via the emergency department (ED), of which 125 (27.2%) occurred during business hours which could have been managed by the CCS. Most people who received care experienced issues associated with disease or treatment and had received systemic anticancer therapy in the past 30 days.
Conclusions The data demonstrate that a significant volume of emergent care was provided within the CCS over the study period, in addition to planned cancer treatment. Due to the ever-increasing demands on EDs and the significant need for emergent care for people with cancer, there is need for CCS-led models of care to provide specialist emergent care specifically for people who are receiving systemic anticancer therapy. Such models must be adequately resourced to meet the needs of patients, carers and healthcare professionals.
What is known about the topic? There is increasing focus on innovative models of emergent care for people with cancer in the out-patient setting to relieve pressure on EDs and improve patient experiences. Limited literature has focused on such models in the Australian context.
What does this paper add? This paper describes, quantifies and profiles care provided in a pragmatic CCS-led model of emergent care in a large tertiary hospital in Australia over 6 months. The data demonstrate significant demand for emergent care within business hours, as well as out of hours, predominantly for people undergoing systemic anticancer therapy.
What are the implications for practitioners? The findings of this study highlight the need for CCS to develop pragmatic models of emergent care. Appropriate resources, infrastructure, policies and procedures are required to adequate meet the needs of patients and carers.
Keywords: avoidable, cancer care, cohort study, department of emergency, emergent care, model of care.
References
[1] RCP. Cancer patients in crisis: Responding to urgent needs. London; 2012.[2] Bureau of Health Information. The Insights Series: Emergency department utilisation by people with cancer. Sydney, NSW; 2014.
[3] Livingston PM, Craike M, Slavin M. Clinical and economic burden of emergency department presentations for neutropenia following outpatient chemotherapy for cancer in Victoria, Australia. Oncologist 2012; 17 998–1004.
| Clinical and economic burden of emergency department presentations for neutropenia following outpatient chemotherapy for cancer in Victoria, Australia.Crossref | GoogleScholarGoogle Scholar | 22707511PubMed |
[4] Shih STF, Mellerick A, Akers G, Whitfield K, Moodie M. Economic assessment of a new model fo care to support patients with cancer experiencing cancer- and treatment-related toxicities. J Oncol Pract 2020;
| Economic assessment of a new model fo care to support patients with cancer experiencing cancer- and treatment-related toxicities.Crossref | GoogleScholarGoogle Scholar |
[5] Insitute of Medicine. Delivering high-quality cancer care: Charting a new course for a system in Crisis. Washington, DC; 2013.
[6] Bray F, Ren JS, Masuyer E, Ferlay J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer 2013; 132 1133–45.
| Global estimates of cancer prevalence for 27 sites in the adult population in 2008.Crossref | GoogleScholarGoogle Scholar | 22752881PubMed |
[7] Northfield S, Button E, Wyld D, Gavin NC, Nasato G, Yates P. Taking care of our own: A narrative review of cancer care services-led models of care providing emergent care to patients with cancer. Eur J Oncol Nurs 2019; 40 85–97.
| Taking care of our own: A narrative review of cancer care services-led models of care providing emergent care to patients with cancer.Crossref | GoogleScholarGoogle Scholar | 31229211PubMed |
[8] van der Meer DM, Weiland TJ, Philip J, Jelinek GA, Boughey M, Knott J, et al Presentation patterns and outcomes of patients with cancer accessing care in emergency departments in Victoria, Australia. Support Care Cancer 2016; 24 1251–60.
| Presentation patterns and outcomes of patients with cancer accessing care in emergency departments in Victoria, Australia. Crossref | GoogleScholarGoogle Scholar | 26306522PubMed |
[9] Díaz-Couselo FA, O’Connor JM, Nervo A, Tossen G, Guercovich A, Puparelli C, et al Nonscheduled consultation in oncologic patients. How many of them are true emergencies? An observational prospective study. Support Care Cancer 2004; 12 274–7.
| Nonscheduled consultation in oncologic patients. How many of them are true emergencies? An observational prospective study.Crossref | GoogleScholarGoogle Scholar | 14735338PubMed |
[10] White K, Roydhouse J, O’Riordan L, Wand T. Interventions for reducing the use of adult Emergency Department services by cancer patients: an Evidence Check rapid review brokered by the Sax Institute (http://www.saxinstitute.org.au) for the Cancer Institute NSW, 2013.
[11] Kuo JC, De Silva M, Diwakarla C, Yip D. A Rapid Access Clinic to improve delivery of ambulatory care to cancer patients. Asia Pac J Clin Oncol 2017; 13 179–84.
| A Rapid Access Clinic to improve delivery of ambulatory care to cancer patients.Crossref | GoogleScholarGoogle Scholar | 28004512PubMed |
[12] Oatley M, Fry M. A nurse practitioner–led model of care improves access, early assessment and integration of oncology services: An evaluation study. Support Care Cancer 2020; 28 5023–9.
| A nurse practitioner–led model of care improves access, early assessment and integration of oncology services: An evaluation study.Crossref | GoogleScholarGoogle Scholar | 32040635PubMed |
[13] McCavery A. A Nurse Practitioner-Led Model to Implement and Deliver Unscheduled Emergency Cancer Care. J Nurse Pract 2020; 16 271–5.
| A Nurse Practitioner-Led Model to Implement and Deliver Unscheduled Emergency Cancer Care.Crossref | GoogleScholarGoogle Scholar |
[14] Cox K, Karikios D, Roydhouse JK, White K. Nurse-led supportive care management: a 6-month review of the role of a nurse practitioner in a chemotherapy unit. Aust Health Rev 2013; 37 632–5.
| Nurse-led supportive care management: a 6-month review of the role of a nurse practitioner in a chemotherapy unit.Crossref | GoogleScholarGoogle Scholar | 24176186PubMed |
[15] Davidson P, Halcomb E, Hickman L, Phillips J, Graham B. Beyond the rhetoric: What do we mean by a ‘model of care’? Faculty of Science, Medicine and Health - Papers: part A. 2006.
[16] Australian Government. My Hospitals: Australian Government; 2019. Available from: https://www.myhospitals.gov.au/hospital/royal-brisbane-and-womens-hospital/emergency-department.
[17] National Health and Medical Research Council. Ethical Considerations in Quality Assurance and Evaluation Activities. 2014. Available from: https://www.nhmrc.gov.au/sites/default/files/documents/attachments/ethical-considerations-in-quality-assurance-and-evaluation-activites.pdf.
[18] eviQ. Telephone Triage Toolkit Australia: eviQ; 2019. Available at: https://www.eviq.org.au/clinical-resources/telephone-triage-toolkit/3637-triage-tool [verified 21 June 2021].
[19] Rosenwax LK, McNamara BA, Murray K, McCabe RJ, Aoun SM, Currow DC. Hospital and emergency department use in the last year of life: a baseline for future modifications to end‐of‐life care. Med J Aust 2011; 194 570–3.
| Hospital and emergency department use in the last year of life: a baseline for future modifications to end‐of‐life care.Crossref | GoogleScholarGoogle Scholar | 21644868PubMed |
[20] Goldsbury DE, O’Connell DL, Girgis A, Wilkinson A, Phillips JL, Davidson PM, et al Acute hospital-based services used by adults during the last year of life in New South Wales, Australia: a population-based retrospective cohort study. BMC Health Serv Res 2015; 15 537
| Acute hospital-based services used by adults during the last year of life in New South Wales, Australia: a population-based retrospective cohort study.Crossref | GoogleScholarGoogle Scholar | 26637373PubMed |
[21] ACSQHC. National Consensus Statement: Essential elements for safe and high-quality end-of-life care. Sydney; 2015.
[22] ACSQHC. National Safety and Quality Health Service Standards (second edition). Sydney; 2017.
[23] Cancer Australia. General Practitioners and Cancer Care Australia: Cancer Australia; 2021. Available from: https://www.canceraustralia.gov.au/clinical-best-practice/cancer-learning/general-practice-and-cancer-care.