Download A systematic approach to dealing with cancer related emergencies

A systematic approach to dealing with
cancer related emergencies
(Acute Oncology)
Jackie Tritton
Nurse Director
Mount Vernon Cancer Network.
YALE International Health Care Management Programme
July 2011
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Problem
The National Chemotherapy Advisory Group report
(NCAG 2009) recommends reform in the way urgent
care is provided for cancer patients. The current
Mount Vernon Cancer Network hub and spoke elective
oncology services model is unable to meet the NCAG
report recommendations thus resulting in delayed
oncology assessment, inappropriate admissions,
prolonged length of stays and poor patient experience.
OBJECTIVES
To establish an integrated Acute Oncology Service (AOS) model
within each of the three acute hospital trusts that:
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Has implemented the five agreed clinical pathways regardless of the
patient’s point of entry into the hospital.
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Provides an AOS educational programme for the Acute Medical and
Accident & Emergency hospital workforce.
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Provides a 24-hour consultant oncologist telephone on-call service for
professionals
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Has established a flagging system which alerts when known cancer
patients are seen in A&E.
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Has an established system for early oncology assessment / review
(within 24 hours).

Has a defined care pathway for the recognition and management of
Metastatic Spinal Cord Compression (MSCC).
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Demonstrates an overall reduction in cancer in-patient length of
stays.
FACTS
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In patient (IP) care accounts for
around 50% of all cancer
expenditure.
IP cancer care accounts for 12% of
all acute in-patients stays.
40% of in-patient cancer stays are
non- elective admissions.
Typical trust has five emergency
cancer admissions a day.
Mt Vernon Cancer Network
Serves a population of 1.4 million.
Covering Herts, Luton and South Beds.

1 Cancer Centre-
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3 Cancer Units
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(Chemotherapy & Radiotherapy-No
surgery or A&E.)
(Chemotherapy, perform common and
specialist designated cancer surgery and four A&E departments )
3 NHS PCT’s.
3 Community Care Services.
9 independent hospice providers.
Why…..
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No capacity in the oncologists’ work plans.
No clear, defined local care pathways in place
No awareness of access to 24 hour Oncology
telephone advice line.
No flagging systems in place.
No network wide treatment protocols.
No training programme for the management of the
Acute Oncology patient
Potential destabilisation of the Cancer Centre
oncologist workforce
**The NCAG report concludes
that the delivery of the service changes
required should not require additional resources and that potential
cost savings from reducing emergency bed days could fund the
service redesign requirements.
AOS Implementation Plan.
Structure:
Establish a MVCN NAOG
•Three locality implementation
groups
•Membership
Agreement of common clinical
pathways.
 Consequences of disease.
 Side effects of treatment.
 Palliative/ End of Life Care.
 Suspected Cancer.
•Network wide symptom
 Non cancer related.
management protocols and
Business Planning:
training
 QIPP - Quality, Innovation,
•Mapping of current policies – to
Prevention & Productivity
identify gaps
 Agreed network wide service
•MVCN AOS Train-the-Trainer
specification.
programme
 Chemotherapy and AOS service
review.
AOS Service Model
 Business case to support trusts
•Proposed AOS triage roles
to invest in AOS, Cost analysis
•Mapping of medical oncology
spend to save
workforce/capacity
•Network wide 24 hour advice
line.
Lessons Learned
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Importance of engagement,
Cost benefits vs outcomes.
Model of care - destabilising
Processes not People.
Importance of patient
engagement and education
Professional tribalism
Managing external influences
and mitigating the risks.
.
EXPECTED OUTCOMES


Reduction in inappropriate
admissions.
Proactive rather than reactive
management of oncology admissions.


Reduction in length of stay for people
admitted with oncology emergencies.


RAPPA, can reduce LOS by 25%.
Evidence that AOS will reduce emergency beds days by
10%
Greater patient satisfaction
However!!
There’s no thrill in easy sailing,
When the sky is clear and blue.
There’s no joy in merely doing
Things which anyone can do.
But there is some fulfillment
That is mighty sweet to take,
When you reach a destination,
You thought you couldn’t make.
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