Download Acute Oncology Briefing 1000 Lives - 25-06-12

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ACUTE ONCOLOGY
BRIEFING NOTE – 25 JUNE 2012
Background
Recent reports from NCEPOD and the NPSA have recommended that a more
systematic approach should be taken to dealing with cancer-related
emergencies. These recommendations have been embodied in the concept of the
'Acute Oncology Service'.
One of the actions of the recent Welsh Government’s ‘Together For Health –
Cancer Delivery Plan’ (2012) is for Local Health Boards to “develop acute
oncology services to support the needs of people admitted as emergencies”. It
goes on to state that there is a need to plan acute oncology services “to deal
with issues such as cancer of unknown primary origin, neutropaenic sepsis and
metastatic spinal cord compression in line with NCEPOD and NICE Guidance.
There is clear evidence, where this is coordinated, patients have reduced
unnecessary tests, admissions and length of stay.”
This has implications across cancer network organisational structures, hospitals
of various types, chemotherapy, radiotherapy and other treatment delivery
services, and primary care functions.
Both Betsi Cadwaladr UHB and the six health Boards in South and Mid Wales
working through the South Wales Cancer Network, are undertaking initiatives to
develop acute oncology services.
A. BETSI CADWALADR UHB – CANCER CLINICAL PROGRAMME GROUP
The Cancer CPG ran a successful Acute Oncology Service Pilot Project in the
Wrexham Maelor Hospital from December 2010, resulting in the establishment of
a formalised Acute Oncology Service at the hospital in March 2012. The CPG is
now committed to rolling out the AOS model to Ysbyty Glan Clwyd and Ysbyty
Gwynedd.
Pivotal to the success of the Pilot in Wrexham was the secondment of an
experienced Advance Nurse Practitioner who has been working closely with a
Speciality Grade doctor to provide a comprehensive AOS.
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The Pilot demonstrated that prior to the development of AOS’s, Oncology care
was recognised as being sub optimal for patients admitted as a consequence of
their chemotherapy treatment, or cancer diagnosis, and did not deliver daily
clinical assessment and decision making by the appropriate speciality.
Audits undertaken nationally have identified the reasons for acute admissions,
the average length of stay following admission and the patient groups in terms
of tumour site most likely affected.
Acute Oncology Service Wrexham Maelor
The AOS enables patients who are currently receiving chemotherapy to be
reviewed daily.
The Acute Oncology Service is also achieving the following;
 Reviews an average 5-7 inpatients daily;
 Ensure that patients with disease progression have been referred
promptly to palliative care, reducing inappropriate attendance for further
chemotherapy and/or review at an OPD;
 Provides telephone support and appropriate signposting to OPD, GP or
other Speciality thus preventing admission to an acute unit;
 Review patients to avoid attendance at ED and inappropriate admission;
 Liaises between Specialities within the hospital and other Cancer Centres;
 Ensures timely assessment of acutely ill patients.
Roll Out
The roll out of the AOS model to both Ysbyty Glan Clwyd and Ysbyty Gwynedd is
on schedule.
Ysbyty Glan Clwyd
The AO team is currently being established and is clinically led by Dr Cath Bale
supported by Dr Carey Smith, Dr Julie Jones and Louise Preston–Jones, Triage
Nurse. Funding for an 18 month period has been secured from charitable funds
to provide backfill for the Triage Nurse whilst she develops the AOS.
An audit will commence on the 11th July for a two week period and will collect
data on acute oncology patients. The audit will be used to assess the impact of
the services as part of a before and after review.
Data
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will be collected on the following categories:
Patient Details
Route into Hospital
Category e.g. CUP etc
Investigations ordered
Length of Stay
Referrals made
Outcome
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The AO team will provide education and awareness sessions to relevant staff on
AMU and the ED as well as presenting at the ground round. It is envisaged that
a full launch of the YGC AOS will take place during September 2012.
Ysbyty Gwynedd
Currently senior members of the Alaw Oncology Unit nursing team visit the
Acute Medical Assessment Unit daily. A bid has been submitted to the BCU
Charitable Fund Committee for funding to release Sister Laura Edge to start
work on the formal YG AOS project.
It should be noted at this point that an electronic patient capture system is a key
requirement for YGC and YG and discussions are underway with the IT Dept.
B. SOUTH WALES CANCER NETWORK
One of the priorities for the South Wales Cancer Network, which covers
Abertawe Bro Morgannwg, Aneurin Bevan, Cardiff & Vale, Cwm Taf and Powys
Health Boards, is the development of acute oncology services in all six health
boards in its area. These services will cover: Patients potentially suffering from the acute complications of cancer
treatment. The emphasis will be on non-surgical treatment, rather than
acute post-operative emergencies;
 Patients potentially suffering from certain emergencies caused by the
disease process itself, whether the primary site is known, unknown or
presumed e.g. Metastatic Spinal Cord Compression (MSCC).
 Services for, acutely presenting cancer including the management of
Cancer of Unknown Primary (CUP).
The Network is undertaking a South Wales Chemotherapy and Acute Oncology
Review in collaboration with Macmillan, leading to the development of proposed
strategies for implementation by the health boards.
Acute Oncology Workshop
In April 2012, the South Wales Cancer Network held a multi-disciplinary Acute
Oncology Workshop attended by over 50 senior clinicians with speakers from a
number of centres in England, demonstrating various models including
consultant-led, and nurse-led services.
Following this workshop, Health Boards are now examining how Acute Oncology
Services could be developed in their locality and a network-wide Working Group
is being established to co-ordinate this and to share ideas across the region
Baseline data on the number of emergency admissions, length of stay, numbers
of Cancer of Unknown Primary etc is being collected for each Health Board. It
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has been estimated that Acute Oncology Service support can reduce admissions
and length of stay by up to 30%.
Acute Oncology Services - Proposed Pilot Project
Work is underway to develop a pilot Acute Oncology Service in Aneurin Bevan
Health Board in partnership with Velindre Cancer Centre. Whilst plans have yet
to be finalised, it is planned that this would be a 7-day a week nurse-led service
with specialist nurses based at hospitals in Aneurin Bevan HB together with
dedicated consultant support from Velindre Cancer Centre. This pilot will look at
a number of measurable outcomes including: a reduction in average length of stay
 improved access to specialist oncology advice
 reduction in unnecessary investigations
 Improved patient experience
Metastatic Spinal Cord Compression
A Clinical Flowchart for the management of MSCC patients in Aneurin Bevan,
Cardiff
&
Vale
and
Cwm
Taf
HB
areas
has
been
published.
(http://howis.wales.nhs.uk/sites3/page.cfm?orgid=983&pid=50719). A similar
pathway is being developed for Abertawe Bro Morgannwg and Hywel Dda HBs.
An educational Workbook has been produced to raise awareness of, and improve
the diagnosis, treatment and management of MSCC. Over 500 copies have
already been distributed. We are currently looking at developing it as an elearning package. A series of locality based MSCC awareness sessions for
physiotherapists have also been held across South Wales with over 170
attending so far, and sessions for GPs are also underway.
1000 LIVES INVOLVEMENT
The Cancer Networks would welcome the advice and support in service
improvement methodology that 1000 Lives could bring to the investigation of
the models for AOS delivery and implementation of selected models throughout
Wales.
For further information contact:
Betsi Cadwaladr UHB – Geraint Ellis Roberts, General Manager, Oncology, Clinical
Haematology & Palliative Care - [email protected] - 01745 445362 (WHTN
1815 5362)
South Wales Cancer Network - Hywel Morgan, Network Director,
[email protected] - 029 2019 6166 (WHTN 1875 6523)
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