Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Reducing preventable emergency visits: Results from the Oncology Nurse Practitioner-led Rapid Access Clinic (RACE) service at a tertiary regional cancer centre            (#53)

Cassandra Mazza 1 , Martina O'Neill 1 , Kacy Ringshaw 1 , Kelly Collins 1 , Lily O'Riley 1 , Madeline Danielsen-Jensen 1 , Natalie Bradford 2 , Nicole Gavin 3 4 5 , Vanessa N Brunelli 6 , Bryan A Chan 1 7 8
  1. Adem Crosby Centre, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
  2. Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia
  3. Cancer Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
  4. Innovation and Research, Community and Oral Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
  5. School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
  6. Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
  7. Griffith University, Nathan, Queensland, Australia
  8. University of the Sunshine Coast, Sippy Downs, Queensland, Australia

Background:

Cancer complications or treatment-related toxicities frequently necessitate urgent evaluation and intervention, often resulting in emergency department (ED) visits and hospitalisations.

To address this, in January 2023, we launched a nurse-led Rapid Access Clinic Expansion (RACE) service, designed to offer a streamlined model for patients undergoing cancer treatment and reduce unnecessary ED presentations.

Aim:

To describe the characteristics, interventions and outcomes for patients who accessed RACE.

Methods:

A retrospective review was conducted of all patients accessing the RACE service from 23 January 2023 to 6 June 2024. Demographics, presenting symptoms, interventions and outcomes were recorded and data analysed using descriptive statistics.

Results:

RACE received 628 telephone calls and managed 337 patients in the study period. 81% (507/628) of calls were managed entirely as outpatients. For most of the calls (530/628, 84%) ED presentation was avoided.

The remaining 98 calls (16%) were appropriately directed to present to the ED.

Patients made on average 1.86 calls (Median 1, Range 1-13)

The median age was 64 years (Range 6-93 years; Standard Deviation 13 years).

Patients accessing the service were receiving systemic intravenous or oral therapies.

The most frequent presenting primary malignancies included:

♦ breast,
♦ colorectal,
♦ upper-gastrointestinal,
♦ gynaecological and,
♦ genitourinary.

Pain, fatigue and decline in performance status were the most frequent presenting symptoms.

All calls were triaged according to the United Kingdom Oncology Nursing Society (UKONS) criteria:

♦ 47.9% self-care advice,

♦ 23.6% clinical review within 24 hours and,

♦28.5% urgent clinical assessment.

Majority of calls 59% (371/628) were managed with phone advice.

Patients managed in the outpatient setting were scripted with required medications or admitted to the day unit for intravenous infusions.

Conclusions:

The RACE service provided streamlined and efficient outpatient care for oncology patients undergoing treatment, whilst reducing ED presentations.

It has been widely accepted by cancer care staff and patients.