Oncology patients often suffer acute medical conditions related to the underlying malignancy, or secondary to toxicity of treatment, which result in presentation to the Emergency department. This often does not require admission, but short treatment which can be administered over several hours. Many oncology units already do this on an informal, ad hoc basis. In January 2015, our institution developed a Rapid Assessment & Supportive Care clinic, involving an avenue for unplanned assessment of oncology patients. This was coordinated by a nurse practitioner candidate, who then involved a medical officer from the oncology team as appropriate.
This study examines the qualitative and quantitative outcomes of implementing the RASC clinic, and explores the challenges and barriers to establishing such a pathway.
Prospective and retrospective data was collected over 18 months, with 12 months prior as a comparator. Clinical casemix data for presenting complaint and outcomes were examined for the most recent six months (analysis in progress)
In the first 12 months of implementation, emergency department admissions decreased by 18% (203 versus 167), but admissions direct to ward (either from clinic or unplanned assessment) increased substantially (78 versus 55). Despite this, total admissions decreased by 6% (245 versus 258). The most common reasons for presentation were nausea, pain and implanted intravenous access issues.
The establishment of an avenue for timely assessment and management for patients who were not unwell enough to require hospital admission led to a reduction in admissions via the Emergency department, as well as less overall need for hospitalisation. Care was less fractionated, and patients either received timely outpatient care or admission facilitated directly to a ward. Quality of life was subjectively improved for patients with expedited access to care.