Elsevier

Clinical Oncology

Volume 21, Issue 3, April 2009, Pages 226-233
Clinical Oncology

Original article
Oncological Emergency Admissions to the Norfolk and Norwich University Hospital: An Audit of Current Arrangements and Patient Satisfaction

https://doi.org/10.1016/j.clon.2008.12.006Get rights and content

Abstract

Aims

To assess current emergency admission pathways for patients with cancer, reasons for admission, subsequent management and patient perceptions of and satisfaction with the care they received.

Materials and methods

A prospective audit was carried out of emergency admissions of patients with cancer over a 3-month period from the beginning of October to the end of December 2007, collecting data at two time points a week, giving a total of 60 patients. The date, time and place of admission, patient demographics (age, gender) and reasons for admission, diagnosis and care pathway were analysed. Questionnaires were completed by a subgroup of 12 patients to assess satisfaction with care.

Results

The mean age was 63.62 years with a range of 29–85 years. Thirty patients were 65 years or older. Lung, bowel, breast, prostate and oesophageal cancers were the most prevalent in terms of emergency admissions. Admissions were grouped into admission due to cancer progression (30/60), treatment-related reasons (20) or for other medical conditions (10). Specialist investigation or management was required by all. Twenty-nine patients were admitted to the Emergency Assessment Unit, 27 were admitted directly to the oncology ward and four patients were admitted through the Accident and Emergency Department. Three patients might have been more appropriately admitted to palliative care services. There was correlation with patient satisfaction and admission to the oncology ward rather than through the Emergency Assessment Unit first.

Conclusion

The cancer burden is increasing, with more patients with cancer being admitted as emergencies. Patients seem to favour continuity of care and admission to an oncology ward directly. Further research needs to be carried out in this area as to how best care may be achieved, taking into account local resources and the changes in practice that have come from continuing treatment much longer into the course of the disease. The organisation of healthcare services has to take account of patient preference to balance efficiency and patient satisfaction. Training in palliative oncology may need to be extended to other groups than oncologists.

Introduction

With an ageing population and improving outcomes of treatment, it has been estimated that by 2020 the incidence of cancer will have increased by 33% and prevalence will increase correspondingly 1, 2. The EUROPREVAL study of cancer prevalence showed that in 1992 around 7.5% of the over 65 years age group had cancer in the UK [3]. This increase in incidence and prevalence will lead to more cancer-related emergencies, which will present a challenge, not only to oncologists, but also to physicians and others working in emergency units [4].

The Emergency Services Action Team Report of 1998 [5] recommended the introduction and creation of medical admissions units to deal with the increased load of emergency admissions to hospitals. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report of 2007 [6] also supported the use of emergency admissions units, claiming that they reduce workload in Accident and Emergency (A&E) departments and length of hospital stay. This pattern of emergency admission may conflict with patients' own preferences for continuity of care [7]. Patients with cancer may feel uncertain about what is going to happen when they are referred to hospital and they may experience psychological morbidity and dissatisfaction with the provision of information and care [8].

These issues, which are critical for patient satisfaction and optimal care, have to be addressed within statutory frameworks of service delivery.

The Cancer Reform Strategy published in December 2007 [9] discussed the need to deliver care in the most appropriate setting and has instigated pilot studies to look at ways of preventing unnecessary hospital admissions and to develop alternative methods of care. It is estimated that avoiding unnecessary admissions might save up to £340 million/year.

The present study was undertaken to audit the current arrangements for cancer emergency admissions for a cancer centre in Norfolk, UK, and to use a questionnaire to assess patients' satisfaction with the admissions process with a view to improving services in the future, taking account of government priorities.

Section snippets

Materials and Methods

The Norfolk and Norwich University Hospital is the largest hospital in Norfolk, with a catchment population of 750 000. It serves as a network cancer centre and also as the district general hospital for about two-thirds of the population of Norfolk. There is an electronic records system available for all patients registered in the oncology department. Patients with cancer needing admission either come into hospital via A&E, through the Emergency Assessment Unit (EAU) or directly to the oncology

Results

In total, 60 patients were admitted during the time period (10 October 2006–21 December 2006), representing 2.7 admissions per time point (Tuesday or Thursday) with between zero and eight patients admitted per day.

The data collected were compared with trust data for the number of emergency admissions and were available for nine of 11 consecutive data points (21 November 2006–19 December 2006): there was good concordance, but not absolute agreement, between the two data sets (Table 1).

The time

Discussion

The medical assessment unit as a model of admission is now central to a patient's pathway as an emergency. Before the 1990s, these units rarely existed and patients were admitted straight from A&E to the ward. The Emergency Strategic Action Team report of 1998 suggested their use to cope with the winter bed pressures at the time and the Royal College of Physicians and the Department of Health supported their creation [5]. Later, the National Health Service plan of 2000 specifically recommended

Conclusion

This audit has shown that most emergency admissions were for cancer-related problems. Various models of care are being piloted, but will require adaptation to meet local situations. Patients seem to favour continuity of care and prefer, in our local situation, to be admitted to the oncology ward rather than through the EAU.

Emergency care of patients with cancer-related problems cannot be optimised without changes in other areas of primary, secondary and tertiary care. Further research needs to

References (11)

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