Acute Oncology Audit Melanie Robertson Nurse Consultant - Oncology City Hospitals Sunderland

Readmissions audits Baseline data prior to Commencing AOS service Audit performed in 2009 and 2010 CHSK live data base –Identified Oncology patients admitted as an emergency within 30 days of attendance in CHDU –Excluded patients on Zometa –Excluded patients admitted as emergency to CHDU and discharged same day (e.g. blood transfusion)

Number of Chemotherapy re- admissions patients –29% via GP –22% via CHDU –13% via GP –6% via E55 (chemo advice ward) –4% Oncology Total of 32% via Oncology Patients

Date from Chemotherapy In both 2009 and 2010 mean admission date following chemo administration was 9.7 / 9.8 days

Admission by Cancer type % Colon 25% Lung 20% Breast Remaining 21% 1 – 4 pts per tumour group % Breast 24% Lung 19% Colon Remaining 16% 1 – 3 pts per tumour group

Chemotherapy Intent % Palliative 27% Adjuvant 4% Down-staging 4% Unknown % Palliative 27% Adjuvant 3% Down-staging 4% Unknown

Common Chemotherapy Regimen % Capecitabine 15% Gem / Carbo 8% Folfiri 7% FEC-T 7% Herceptin % FEC-T 12% Gem / Carbo 7% Folfiri 7% Carbo / Etop

Course Number 2009 C1 - 26% C2 - 18% C3 - 11% C4 - 17% C5 – 8% C6 – 8% 2010 C1 - 34% C2 - 15% C3 - 9% C4 - 23% C5 – 6% C6 – 4%

Length of Stay 2009 Range 0-48 days Mean 6.5 days Median 5 days 2010 Range 0-15 days Mean 5 days Median 4 days

Top 5 Reasons for admission 2009 Abdominal pain18% Dyspnoea14% Neutropenic sepsis10% Nausea and vomiting 7% Pyrexia7%

Abdominal pain 13 Patients admitted with Abdominal pain –11 Colon cancer 6 Capecitabine 4 Folfiri 1 Folfox –1 Breast –1 Ovarian

Neutropenic sepsis 7 Patients admitted with Neutropenic Sepsis –5 Breast cancer 3 FEC-T 1 Docetaxel 1 CMF –1 Lung –1 Ovarian

Capecitabine 20 patients admitted following Capecitabine –4 Abdominal Pain –2 DVT –2 Generally Unwell 12 other patients admitted with Nausea, chest pain, swollen testicle, CVA, Cervicalgia, Pyrexia, Cellulitis, ?MSCC, Aescites, Encephalopathy, Raised INR, Loin Pain.

Admitting specialty % General Medicine 15% Chest Medicine 11% Gastroenterology 11% Cardiology 10% General Surgery 8% Haematology % General Medicine 18% Chest Medicine 17% Haematology 12% Care of the Elderly 9% Gastroenterology 7% General Surgery

Key findings Use of the AOS team required as route to hospital is predominantly not via Oncology Further analysis of 2010 data –Why has the colon cancer admissions reduced? –What are the reasons for admission particularly with Breast patients. Opportunity for proactive telephone follow up. (? Palliative, C1)

Thank you Questions / Comments