Cathy Hutchison; Dawn Lindsay; Allison Freeman; Elinor Ward Beatson West of Scotland Cancer Centre - Clinical Governance Support Unit

1. PATIENTS WITHIN 6 WEEKS OF TREATMENT (n=210 attendances)
MOST RECENT TREATMENT TYPE
A subset analysis was carried out
on the patients who were within
6 weeks of treatment, excluding
patients who had ‘Fall / Traumatic
Injury’ in the database as their
‘Reason for Attendance’. 195
patients had 210 attendances
which is an average of 7.5 patients
per day. The top 3 cancer types
were: Breast 29% (n=57); Urology
24% (n=46) and Haematology
14% (n=28).
Patients with Cancer or Suspected Cancer Presenting at
QEUH as Emergency/Unscheduled Attendances
Cathy Hutchison1
; Dawn Lindsay1
; Allison Freeman2
; Elinor Ward1
1
Beatson West of Scotland Cancer Centre 2
Clinical Governance Support Unit
295288
INTRODUCTION
Patients with cancer being treated at the Beatson West of Scotland Cancer Centre can be admitted
anywhere in the West of Scotland when they become unwell, however a large proportion will come to
Queen Elizabeth University Hospital (QEUH). This audit was undertaken to quantify and understand
the referral, presentation and management of patients with cancer and suspected cancer presenting
unscheduled at QEUH, during a 28 day period.
METHOD
Identification of patients
During February 2016, Daily Emergency Department (ED) lists of all attendances (from Trakcare), and
Immediate Assessment Unit (IAU) /Acute Receiving lists (from ward receptionists), were screened to identify
patients with either a previously diagnosed cancer or being investigated for suspected cancer. This was
done by checking clinical information on Clinical Portal for all CHI numbers on these lists. In addition,
clinicians from QEUH and the Beatson West of Scotland Cancer Centre (BWoSCC) submitted names of
patients they were aware of who had attended QEUH 1-28th February. Direct admissions of patients with
cancer or suspected cancer to Infectious Diseases, Institute of Neurosciences, and Gynaecology via the
Gynaecology Assessment Area, were identified from local contacts.
This process involved screening of 9308 CHI numbers for attendances, and resulted in identifying 749
attendances (8%) from 701 patients.
Suspected Cancer
2 – 13 attendances per day
Previously Confimred
Cancer
5-35 attendances per day
Total Audit Sample
749 Attendances
7–48 attendances per day
9308 Unscheduled Attendances
Screened for cancer diagnosis/suspected new cancer
9 patients had Cancer of Unknown Primary
749 Attendances from 701 patients
Previously Known Cancer
575 Attendances
(from 530 patients)
Includes 6 patients who also
had a suspected new cancer
Suspected New Cancer
174 Attendances
(from 171 patients)
59 patients (62 attendances)
went on to have this confirmed
Process for data collection & entry
Individual patient proformas were completed for the 749 attendances by oncology nurses accessing
Clinical Portal, Trakcare, casenotes and from communication with the patient’s clinical team. The forms
were then entered into a Microsoft Access database.
RESULTS
ALL PATIENT ATTENDANCES (n=749)
CAUSE OF MAIN REASON FOR ATTENDING
Most patients who attended QUEH
attended for a cause unrelated to their
cancer (38%), with 26% attending for
investigation of suspected cancer, 25%
for cancer related effects and 11% for
treatment toxicities. The 2 patient’s
classed as other were ‘patient discharged
prior to review’ and ‘post testicular surgery
wound infection’.
CONCLUSION
Identification processes were effective in highlighting the unscheduled/emergency cancer and suspected
cancer attendances (+/- admissions) to QEUH in February 2016. This audit has provided valuable
information about the patient population and has been used to develop a substantive in-reach service
from the cancer centre, commencing February 2017.
Acknowledgements
QEUH staff for support/access/practical help/advice: in particular, David Raeside, Debbie Ambridge, Gerry Wright. Mary Fraser , Carol Grant & Christine Dunn, Jean
McFarlane, Joe Sarvesvaran , Scott Davidson, Alistair McKeown, Cathy Muir, Kevin Begbie, Fiona Bernclaw & Carol Curran. Reception, Nursing & Medical staff in IAU, Acute
Receiving & ED. Beatson staff: in particular, Carolyn McGillivray & Louise MacLean , Judith Roulston , Jane Edgecombe, Jonathan Hicks, Anne McKillop, Melanie McColgan,
Myra Campbell & Maureen Grant.NHSGGC Medical Illustration.
OUTCOME OF ATTENDANCE
79% (n=589) of all attendances resulted in
admission 20% (n=153) were discharged
home after being seen. 0.7% died in ED/
AU and 0.2% were transferred to a BWoSCC
ward (1 patient).
PATIENTS WITH SUSPECTED CANCER (n=177)
NUMBERS OF SUSPECTED CANCER
177 patients (25%) had a suspicion of cancer, of whom 6 had a previous cancer diagnosis – 1 each of
Urology, Skin, Gyn, Haematology & 2 of Breast.
59 (33%) then had a new cancer confirmed.
TOP 3 MAIN REASONS FOR ATTENDANCE
Abdominal Pain (25%), Respiratory Symptoms (17%), Neurological symptoms (8%).
TOP 3 MAIN REASONS FOR ADMISSION
Abdominal pain (23%), confusion/disorientation (10%), DVT/PE symptoms (10%).
PATIENTS WITH A PREVIOUS CANCER DIAGNOSIS (n=530)
WHEN 1st DIAGNOSED
35% of patients already with a cancer
diagnosis when they attended QEUH
(106/530) had been diagnosed within the
previous 12 months. This was 75% within
the previous 5 years (n=398).
TUMOUR SITE
The 3 most common cancer types were:
Urology 20% of patients (n=105), Breast 17%
(n=92) and then lung at 13% (n=70). 32% had
advanced or metastatic disease.
MOST RECENT TREATMENT (n=575 attendances)
The most common treatment in the cancer diagnosis group was Systemic Anti Cancer Therapy (SACT)
(28%) followed by surgery at 26% (n=139).
10% of patients (n=52) had had no previous treatment for their cancer.
199 patients were within 6 weeks of treatment, which resulted in 221 attendances.
DATE OF MOST RECENT TREATMENT
PREVIOUS MEDICAL MANAGEMENT (n=575)
69% of all attendances of patients with previously diagnosed cancer had been seen in the past by oncology
or haematology, 25% by surgeons only and 3.5% by chest physicians only. The remainder were other
specialties or none.
10% were known to palliative care services.
TOP 3 MAIN REASONS FOR ATTENDANCE
Respiratory symptoms (18%)
Abdominal pain (12%)
Neurological symptoms (9%)
TOP 3 MAIN REASONS FOR ADMISSION
Progression of cancer (17%),
Chest infection /pneumonia (13%)
Sepsis/neutropenic sepsis (10%)
TOP 10 REASONS FOR ATTENDING QEUH
No of attendances %
Respiratory Symptoms 30 14
Abdominal Pain 24 11
Suspected / Neutropenic Sepsis 23 11
Urological Problems 22 10
Neurological Symptoms 17 8
Chest Pain / Cardiac 12 6
Nausea Vomiting 11 5
Pain 10 5
Wound Problems / Infection 10 5
Fatigue / Malaise 10 5
CAUSE OF MAIN REASON FOR ATTENDING:
MAIN REASON FOR ADMISSION (n=158)
A total of 158 attendances resulted in admission to a ward (75%).
No of patient attendances %
Progression of Cancer 25 16
Urological Problems 15 10
Neutropenic Sepsis 14 9
Sepsis (Not Neutropenic) 13 8
Chest Infection or Pneumonia 13 8
Abdominal Pain 11 7
Other 12 7
DVT / PE 10 6
Fluid Electrolyte Imbalance 8 5
Post Surgical Complications 7 4
LENGTH OF STAY (LOS):
Median LOS: 5 days Mean LOS: 10 days Range: 1-86 days
CONTACT WITH ONCOLOGY/PALLIATIVE CARE
For 26% of attendances/admissions, there was a record of contact with the patient’s oncology team,
although 89% of the patients within 6 weeks of treatment were already known to the specialist oncology
team.
16% of all admissions were seen by palliative care during admission