Thursday 20th June 2013
Nicky Hand on the Macmillan Acute Oncology Assessment Unit at South Tees Hospitals NHS Foundation Trust.
The publication, on 24 August 2009, of the National Chemotherapy Advisory Group report Chemotherapy services in England: Ensuring quality and safety [PDF 1.55MB] highlighted a number of areas of chemotherapy services requiring review.
By far the most sweeping of its recommendations was that all hospitals with an accident and emergency (A&E) should establish an acute oncology service, bringing together oncology, acute and emergency medicine.
South Tees Hospitals NHS Foundation Trust has a long history of working in partnership with Macmillan Cancer Support. The successful implementation of an acute oncology service, through initial funding of two nursing posts by Macmillan, has enabled the trust to develop the concept of an acute oncology service and secure a purpose-built assessment unit that works alongside it.
With a grant from Macmillan, a traditional six-bedded ward was remodelled and can now take three unwell patients from primary care. It also has a seating area for triage where patients experiencing symptoms from their disease, or side effects, can be assessed and, if necessary, be treated quickly and effectively without having to attend the A&E department.
The advantages of this model are:
- patients are assessed quickly and effectively by oncology-trained doctors and nurses
- treatments begin without delay, such as antibiotics for neutropenic sepsis
- nurse-led services or pathways are established
- avoidance of unnecessary admissions to inpatient beds
- reduced length of stay once the underlying medical condition has been treated, allowing the patient to be discharged more quickly and efficiently.
The Macmillan Acute Oncology Assessment Unit opened on 5 November 2012. By 5 January 2013, it had received 98 admissions and had seen a significant improvement in the cancer patient pathway.
Reasons for admission vary, with suspected neutropenic sepsis and nausea and vomiting being the most common. Of those admitted, 65% were discharged the same day, requiring no inpatient stay. Of those discharged, one patient was reassessed and subsequently admitted within a 12-hour time-frame. Patients who are acutely unwell and require admission following assessment using the UKONS 24-hour triage tool are admitted to the nurse-led unit, assessed and treated appropriately.
A prospective patient experience survey has been developed, which shows that patient and carer experience of the unit is high.
Responses included such comments as:
- a professional team
- a calm environment to be treated in
- excellent service and set-up in the unit
- very helpful staff
- the service we received was excellent
- a very pleasant ward to be treated and diagnosed in
- staff were very nice, they couldn’t do enough for us
- all staff were extremely helpful and thorough
- staff were very friendly and explained everything that was happening.
Email Nicky Hand, Macmillan Lead Nurse and Nurse Consultant, South Tees Hospitals.