Emergency admissions and subsequent inpatient care through an emergency oncology service at a tertiary cancer centre: service users’ experiences and views
Avoiding unnecessary emergency admissions and managing those that are admitted more effectively is a major concern for both patients and health services. To generate evidence useful for improving services for direct patient benefit, this study explores service users’ views and experiences of emergency admissions and subsequent inpatient care.
Participants were recruited during a cancer-related emergency admission from a tertiary cancer centre with an emergency oncology service and emergency department. Semi-structured interviews were conducted with 15 patients and 12 carers post hospital discharge. Interview transcripts were analyzed using framework analysis.
Twenty patients experienced 43 emergency admissions over 6 months. Most admissions (35/43) followed patients presenting acutely or as emergencies with cancer treatment side effects. Most admissions (35/43) were directly to an oncology ward following specialist advice, review and triage, and thus unavoidable. Participants experienced outstanding inpatient care because of the following: prompt and effective symptom control and stabilization of acute conditions; continuity of cancer care and coordination between acute and long-term treatment; satisfactory professional-patient communication and information sharing; responsive, motivated and competent staff; and less restrictive visiting times. Gaps in care were identified.
Many emergency admissions are necessary for people with cancer. Future work should focus on improving easy access to specialist advice and triage, and the process of admission; providing rapid palliation of symptoms and prompt stabilization of acute conditions, and satisfactory inpatient care; closing the circle of care for patients by actively involving primary care and palliative/end-of-life care services to address the complex needs of patients and carers.
KeywordsCancer Outpatient Side effect Emergency admission Inpatient care Users’ experience
We are grateful to patients and their carers for their participation during a difficult time. We thank Thomas Hammond for his admin support and Sarah Smith for participant recruitment.
This work was supported by a University of Hull Endowment award from Yorkshire Cancer Research (Ref: HEND001).
Compliance with ethical standards
The authors declare that they have no competing interests.
All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.National Audit Office (2013) Emergency admissions to hospital: managing the demand. TSO (The Stationery Office), LondonGoogle Scholar
- 2.Blunt I, Bardsley M, Dixon J (2010) Trends in emergency admissions in England 2004–2009. The Nuffield Trust, LondonGoogle Scholar
- 5.The NHS Confederation (2011) Briefing 211: the impact of non-payment for acute readmissions. The NHS Confederation, LondonGoogle Scholar
- 6.Tian Y, Dixon A, Gao H (2012) Data briefing: emergency hospital admissions for ambulatory care-sensitive conditions. The King’s Fund, LondonGoogle Scholar
- 7.Department of Health (2012) The NHS outcomes framework 2013/14. Department of Health, LondonGoogle Scholar
- 8.National Audit Office (2010) Delivering the cancer reform strategy. National Audit Office, LondonGoogle Scholar
- 10.Royal College of Physicians and Royal College of Radiologists (2012) Cancer patients in crisis: responding to urgent needs. Report of a working party. RCP, LondonGoogle Scholar
- 11.Henson LA, Higginson IJ, Daveson BA, Ellis-Smith C, Koffman J, Morgan M, Gao W, on behalf of BuildCARE (2016) “I’ll be in a safe place”: a qualitative study of the decisions taken by people with advanced cancer to seek emergency department care. BMJ Support Palliat Care 6:394. https://doi.org/10.1136/bmjspcare-2016-001204.28 CrossRefGoogle Scholar
- 13.Numico G, Cristofano A, Mozzicafreddo A, Cursio OE, Franco P, Courthod G, Trogu A, Malossi A, Cucchi M, Sirotovà Z, Alvaro MR, Stella A, Grasso F, Spinazzé S, Silvestris N (2015) Hospital admission of cancer patients: avoidable practice or necessary care? PLoS One 10:e0120827. https://doi.org/10.1371/journal.pone.0120827 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Karasouli E, Munday D, Bailey C, Staniszewska S, Hewison A, Griffiths F (2016) Qualitative critical incident study of patients’ experiences leading to emergency hospital admission with advanced respiratory illness. BMJ Open 6:e009030. https://doi.org/10.1136/bmjopen-2015-009030 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Teno JM, Gozalo PL, Bynum JPW, Leland NE, Miller SC, Morden NE, Scupp T, Goodman DC, Mor V (2013) Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA 309:470–477. https://doi.org/10.1001/jama.2012.207624 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Foltran L, Aprile G, Pisa FE, Ermacora P, Pella N, Iaiza E, Poletto E, Lutrino SE, Mazzer M, Giovannoni M, Cardellino GG, Puglisi F, Fasola G (2014) Risk of unplanned visits for colorectal cancer outpatients receiving chemotherapy: a case-crossover study. Support Care Cancer 22:2527–2533CrossRefGoogle Scholar
- 25.Baena-Cañada JM, Estalella-Mendoza S, Rosado-Varela P, Expósito-Álvarez I, González-Guerrero M, Díaz-Blanco MC, Cortés-Carmona C, Ramírez-Daffós P, Arriola-Arellano E, Rueda-Ramos A, Solana-Grimaldi L, Benítez-Rodríguez E (2012) Use of health-care services during chemotherapy for breast cancer. Eur J Cancer 48:3328–3334. https://doi.org/10.1016/j.ejca.2012.04.024 CrossRefPubMedGoogle Scholar
- 28.Purdy S (2010) Avoiding hospital admissions: what does the research evidence say? The King’s Fund, LondonGoogle Scholar
- 30.The UK Oncology Nursing Society (UKONS) (2016) Oncology/haematology 24-hour triage toolkit. UKONS, MarlowGoogle Scholar
- 31.Palys T (2008) Purposive sampling. In: Given LM (ed) The sage encyclopedia of qualitative research methods, vol 2. Sage, Los Angeles, pp 697–698Google Scholar
- 34.Ritchie J, Spencer L (1994) Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG (eds) Analysing qualitative data. 1st edn. Routledge, London, pp 173–194Google Scholar
- 37.Warrington L, Holch P, Kenyon L, Hector C, Kozlowska K, Kenny AM, Ziegler L, Velikova G (2016) An audit of acute oncology services: patient experiences of admission procedures and staff utilisation of a new telephone triage system. Support Care Cancer 24:5041–5048. https://doi.org/10.1007/s00520-016-3370-4 CrossRefPubMedGoogle Scholar
- 40.Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C, de Wit N, Zimmermann C (2015) The expanding role of primary care in cancer control. Lancet Oncol 16:1231–1272CrossRefGoogle Scholar