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Supporting Scotland’s first 24 Hour Cancer Treatment Helpline in a Regional Cancer Centre Jackie Whigham, Project Manager for Acute Oncology and Caroline McKinnel, Lead Nurse Chemotherapy Quality. Edinburgh Cancer Centre. Introduction Evaluation Recent reports(1) and guidance(2) have highlighted that failure to provide access to timely advice and assessment for patients receiving systemic anti cancer therapy (SACT)/radiotherapy potentially compromises patient safety. Chief Executive Letter 30(3) (CEL30) states that all Scottish health boards must develop pathways which enable patients access to timely advice and assessment 24 hours a day. In addition to meeting the challenges, evaluation has been built in by: 1.Measuring the impact through audit: Analysis of 12 month data has demonstrated a variety of benefits including; 1.Provide 24 hour telephone triage for patients receiving SACT/ radiotherapy at the Edinburgh Cancer Centre (ECC). 2. Develop local assessment pathways for patients living within and out with the Edinburgh Cancer Centre. 3.Develop a seamless communication process for recording outcomes following triage. The Response 1.The Edinburgh Cancer Centre joined the Scottish Cancer Treatment Helpline (CTH) in June 2013, (Figure 1). 2. Local assessment pathways were implemented with additional follow up service for patients whose symptoms require assessment, but who do not need to be admitted to hospital. 3. A seamless internal process implemented to ensure clinical prescribers have up to date information, (Figure 2), following CTH triage. • Local assessments, (Figure 4) • Reduction in number of patients requiring admission following assessment, (Figure 5). 2.Capturing the experience of patients and Health Care Professionals (HCPs): Patients were positive describing it as highly accessible and very reassuring. The HCPs interviewed were supportive of CTH and positive about the direction in which it was developing. Figure 3: Day of week patients call. 20 Percentage (%) The Challenge • Calls now consistently spread evenly over the week, (Figure 3) 15 5 0 Patient is managed according to triaged alert Green = Self Care Advice Amber = Thu Sat Sun 27 13 10 D&G Other Forth Valley Fri 1548 400 199 ECC safety check: 1. CTH outcome 2. Acute care outcome 198 31 Lothian Fife West Borders Lothian Location Assessment required within secondary health care setting Figure 5: Number of CTH patients discharged following assessment. 80 Percentage (%) Completed tool is electronically auto – shared with the prescribing and primary care team Figure 2: Chemocare where outcomes are documented. Wed 800 0 Double Amber or Red = INFORMATION FOR AMBULANCE If patient well on arrival or refuse to travel contact CTH number above Tue 1200 Follow up within 24hrs CTH team Cancer Treatment Helpline 0800 917 7711 Mon Day of the Week Number of Patients Front End: 24 hour Cancer Treatment Helpline CTH Call operator triages patients symptoms according to the UKONS tool with Immediate Life Threatening questions 1st and access to order 999 Ambulance Poly Post CTH 10 1600 Patient is triaged using UKONS tool Pre CTH Post CTH Figure 4: Assessment location (July 2013 – June 2014). Figure 1: CTH model which uses UKONS tool to triage(4). Patient at home has a health concern Poly Pre CTH 70 % Calls sent for assessment 60 50 % Discharged following assessment 40 30 Mon Tue Wed Thu Fri Sat Sun Day of the Week Summary Developing the infrastructure to support the CTH within the ECC has been a significant piece of work. As a result patients with SACT/radiotherapy related toxicities now have access to a more robust, consistent and equitable 24 hour triage, and those who require it have access to effective, timely assessment near to home. Clinicians/prescribers have up to date information in relation to outcomes following CTH triage. Most importantly, both patients and healthcare professionals are in agreement that this change represents an improvement in the care received by patients with cancer. The CTH service will be rolled out throughout Scotland by the end of 2014. References: (1). National Confidential Enquiry into Patient Outcome and Death report: Systemic Anti-Cancer Therapy: For better, for worse? (2008). http://www.ncepod.org.uk/2008sact.htm. (2). Assessment, Diagnosis and Management of Neutropenic Sepsis – Best Practice Statement. http://www.scotland.gov.uk/Topics/Health/health/cancer/publications/bestpracticestatement. (3). Chief Executive Letter 30. http://www.sehd.scot.nhs.uk/mels/CEL2012_30.pdf. (4). UKONS Rapid Assessment and Access Toolkit – Evaluation Report 2010. http://www.ukons.org/docs/24%20evaluation.pdf