CN70 - Out of hours symptom triage and supportive care

Background

Cancer-related Emergency Department (ED) presentations are increasing rapidly, leading to increased utilisation and pressure on EDs. This impacts on their ability to provide timely, high-quality patient care. Nurse-led telephone triage (TT) services have been implemented in many oncology centres. Despite this there have been relatively little study of its ability to reduce ED utilisation. This study was conducted in Beaumont Hospital, a tertiary academic centre in Dublin serving a population of one million. The primary aim of this study was to assess the impact of the TT service in preventing ED presentations and the characteristics of patients accessing the service.

Methods

All patients receiving cancer treatment have a 24-hour contact number for specialist advice. Nurses are trained to assess patients by the UKONS Toolkit and to perform autonomous interventions for grade 1-2 events or refer to the oncologist on-call for higher grade events. Data was collected retrospectively from paper logs recorded over the 2022 calendar year. Patient and disease characteristics, presenting symptoms and the timing of calls were compared between those advised to attend and managed successfully over the phone.

Results

The TT service received 383 calls over the study period. The mean (SD) patient age was 56yrs (15.04); 199 (52%) were female. Of the 383 patients, 182 (47%) were referred to ED while 201 (53%) avoided it. Admission demographics, cancer types and treatment modalities were similar between groups. Patients who avoided an ED referral were significantly more likely to have a chemotherapy/ medication, genitourinary or miscellaneous complaint, while those with infectious issues were more likely to be referred. Most phone calls (65%) occurred at the weekend. Calls during working hours were more likely to avoid referral.

Conclusions

The majority of patients avoided attending the ED and the triage service was particularly effective in dealing with chemotherapy/ medication and genitourinary issues. Symptoms related to infectious issues were referred more frequently. Future steps could include increasing weekend staffing and integrating the TT service with the national oncology electronic health record system to further improve decision making by providing timely access to detailed patient information.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Beaumont RCSI Cancer Centre.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.