Attendances at the A&E Department in Patients receiving Chemotherapy Dr Sandra Distefano Ms Danika Marmara Directorate for Health Information & Research Clinical Performance Unit 20th October 2017

‘Health data constitutes a significant resource in most OECD countries and it makes economic and ethical sense to use this data as much as possible to improve population health and to improve the effectiveness, safety and patient-centeredness of healthcare systems’ Strengthening Health Information Infrastructure for Health Care Quality Governance (OECD Health policy studies 2013) #PHSymposium17

Introduction Physicians at the A&E department are aware that patients who are undergoing chemotherapy or who have undergone chemotherapy in the preceding months, often present at the A&E Department with diverse complaints however the actual frequency or the reason for such visits has not been determined. #PHSymposium17

Aims and Objectives The main objective of this analysis was to identify and quantify the number of attendances at the A&E department who had a chemotherapy session prior to the A&E attendance To find which are the most frequent complaints in such patients To estimate the time lapse between chemotherapy treatment and the patient visit to the A&E department #PHSymposium17

Methodology The dataset was extracted by linking the ID card numbers of episodes of chemotherapy and/or monoclonal antibodies (MABS) administration in the period July 2015 till June 2016 (as supplied by the Pharmacy Department) with the A&E attendances (source: CPAS) during the same period. The dataset thus obtained was then further linked with the CPAS admissions between July 2015 and June 2016 to find those A&E attendances who were admitted to an in-patient ward. #PHSymposium17

Limitations of this Analysis The following limitations should be taken into consideration in this analysis:    All A&E attendances which linked with the chemotherapy list were included in the analysis. Thus any A&E attendances which may have been due to a complaint not associated with chemotherapy were included in the analysis, such as those following an injury or due to the malignant neoplasm itself.   One should also note that monoclonal antibodies were included in the list of chemotherapy and such drugs are also used to treat other non malignant diseases. #PHSymposium17

Analysis The number of A&E attendances between July 2015 and June 2016, which linked with the chemotherapy administration list during the same period amounted to 1553 A&E attendances. This gives an average of 4 daily A&E attendances who had a chemotherapy session prior to presenting at the A&E Department. The average lag between chemotherapy administration and the A&E Attendance was of 44 days (6 weeks) whilst the median stood at 12 days. 66% of all A&E attendances presented at the A&E Department within 30 days of receiving chemotherapy. #PHSymposium17

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ESI categories of A&E Attendances The Emergency Severity Index (ESI) categories of these 1553 attendances show that the greatest proportion (87%) was categorised as ESI 2 and 3, these being the more urgent cases. Common Complaints documented at Triage 15% had fever 13% had vomiting 12% had abdominal pain 7% had chest pain #PHSymposium17

Admissions through the A&E Dept Of the 1553 A&E attendances: 903 (58%) were admitted to an in-patient ward This amounts to an average of 2 admissions per day. The average length of stay of these admissions was 7.5 days #PHSymposium17

Conclusion An average of 4 daily A&E attendances, who had been administered chemotherapy, were registered at the A&E Department between July 2015 and June 2016. Of these, 87% were categorised as ESI 1, 2 or 3. Furthermore, 58% were admitted to an in-patient ward. This amounts to an average of 2 admissions per day. The average length of stay of these admissions was 7.5 days. #PHSymposium17

Conclusion (cont) Patients who are receiving or have received chemotherapy are often immunocompromised and should not be exposed to infectious agents which are usually plentiful in a busy A&E waiting area. Knowing the number, as well as the reasons why such patients seek medical care at the A&E Department, can provide hospital policy makers with information to plan and provide a dedicated service, such as a segregated waiting area and a fast track through the A&E journey, to these patients. #PHSymposium17

Thank you! #PHSymposium17