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