Emergency department to discharge pathways for oncology patients undergoing cancer treatment : a clinical audit

Abstract

Background: The alarming cancer incidence rates, increased survival, an aging comorbid population, and complications of novel treatments, contribute to a growing demand for emergency and acute oncology services. A pilot acute oncology service pathway was launched in January 2022. This clinical audit was the first to investigate patient pathways from emergency presentation until discharge. Objective: To analyse the local acute oncology pathway for oncology patients undergoing cancer treatment and leverage findings as a quality improvement initiative, to enhance the acute oncology service aiming for high quality patient care, cost effectiveness and overall improve oncology care delivery. Methodology: A quantitative, retrospective longitudinal design. Data of all adult oncology patients who received cancer treatment from 1st August 2023 to 31st July 2024 were collected from the oncology electronic health record system. Eligible patients were linked to the patient’s administrative system to identify unplanned hospital visits, that occurred within six weeks from treatment. Descriptive and inferential statistics were conducted using SPSS. Findings: Among 1,514 patients undergoing anti-neoplastic treatments, 828 (54.7%) had 1,510 emergency department visits. On average, 4 emergency department visits and 3 hospitalizations were recorded daily. Common presenting symptoms included fever (20.9%), dyspnoea (11.7%), pain (6.6%), vomiting (6.5%) and abdominal pain/distension (6.5%). Of 1,510 emergency department visits, 1,064 hospitalisations were reported for 638 individuals. 96.1% of admissions were reported in the general acute hospital, with most admissions occurring in general medical wards (40.9%). The mean length of stay was approximately 8 days, and an approximate of 24 hospital beds were occupied by these patients on a daily average. Conclusion: To address the shortcomings identified along the pathway, a multi-faceted quality improvement plan proposed strategies to identify high-risk for acute care use, enhance accessibility and coordination, ensure standard clinical pathways for symptom management, develop emergency oncology care tactics, and promote early palliative care.