Summary
Doncaster CCG funded the recruitment of two additional acute oncology specialist (AOS) nurses to pilot an 8am-8pm, 7 days a week, including bank holidays, service at Doncaster Royal Infirmary. Bassetlaw Hospital continues to have a 9am-5pm service and telephone advice is given by the AOS Nurse after 5pm and during the weekends. The hours 8am-8pm were chosen in line with the hours that other professionals work, for example the 8-8 walk-in centre. 306 patients were seen during the pilot period of October – March and of these 151 were seen in the new working hours.
Challenge
National reports identified serious concerns about the quality and safety of services for cancer patients presenting to acute hospitals as emergencies. Hospitals were therefore required to develop an Acute Oncology Service (AOS) and set up an Acute Oncology Team (AOT). Poor communication between teams, especially from primary to secondary care, was found and a need for specialist presence out of hours highlighted. There were also concerns from the Doncaster CCG around the number of emergency admissions related to a patient cancer diagnosis.
The current service operated from 9am-5pm, so only a third of patients were seen. A need to extend working hours to include weekends and bank holidays was identified. Funding was obtained from Doncaster CCG for a six-month pilot.
Objectives
The project aimed to provide an out-of-hours service for cancer patients presenting as an emergency to Doncaster Royal Infirmary. Bassetlaw Hospital would continue to have a 9am-5pm service Monday to Friday, with telephone advice out of hours from the AO clinical nurse specialist (CNS) at Doncaster.
Objectives included saving patients from unnecessary tests and emergency admission to hospital, ensuring rapid assessment and triage of cancer patients presenting as emergencies, and improving the quality of patient and carer experience.
The team also wanted to support generalist staff when oncological expertise is required.
The project required the AOT to provide education sessions to staff in emergency receiving areas (A&E/MAU) and community staff such as nurses and GPs.
Solution
Doncaster CCG provided funding for two extra Band 7 nurses, making a total of four AO CNSs working together across two acute hospital sites. The AO CNSs receives an alert for all cancer patients, enabling to assess and triage the patient within the hour.
Publicity and awareness of the new AOS OOH service was through posters, and face to face encounters with staff. The Trust and the local press were involved. The service was also advertised in the Nursing Standard and Cancer Nursing Practice magazines as an area of innovation in Doncaster.
The education sessions provided were two-hour sessions provided to community staff, including GPs and staff in emergency receiving areas of the acute trust. This was also evaluated using a feedback questionnaire completed once the education was delivered.
Results
During the pilot, 306 patients were seen. Almost two thirds (62 per cent) had their initial presentation in the A&E department.
Almost half (49 per cent) attended due to disease progression and 39 per cent following treatment. Sixty five per cent made their own way to hospital, while 16 per cent were advised to come by their GP. The evaluation showed the need for specialist presence out of hours. This ensured patients were seen promptly and treatment plans formulated.
The team developed an educational package for doctors and senior nurses on both sites, as well as in the Doncaster Health Community, delivering 22 two-hour sessions. Of the 106 admissions prevented, 24 were within the new working hours.
Learnings
The team began with a scoping exercise, to identify where the service was needed. They learnt that robust data is vital to demonstrate need of service, and that it was essential to plan services to meet organisational, staff, patient and carer needs.
Using resources effectively was another key lesson. Having staff cover for one another both saved resources and enabled skills development.
Engaging with extended team members to find out their concerns and sharing ideas for service development worked well within the project. Engaging with other providers proved especially important as, had it not been for Doncaster CCG funding the pilot, it may have been some time before it took place.
Evaluation
The pilot provided improved patient experience and prompt, appropriate emergency treatment. Robust care pathways and safe services were provided across the network. An education package was rolled out, recognising acute oncology presentations and raising awareness of treatment pathways.
A minimal number of readmissions were recorded and the trust’s cancer average length of stay fell by 2.8 days during the pilot. Cancer peer review measures for acute oncology and CUP were met.
The evaluation results were shared within the trust, Doncaster CCG and the network sub-group. The team feels the nurse-led model is transferable to other AOS services. Team members have been approached by the diabetes team and the respiratory nursing team for advice and assistance in planning for seven-day working.
