Oncological emergency admissions to the Norfolk and Norwich University Hospital: an audit of current arrangements and patient satisfaction.

AIMS: To assess current emergency admission pathways for patients with cancer, reasons for admission, subsequent management and patient perceptions of and satisfaction with the care they received.
MATERIALS AND METHODS: A prospective audit was carried out of emergency admissions of patients with cancer over a 3-month period from the beginning of October to the end of December 2007, collecting data at two time points a week, giving a total of 60 patients. The date, time and place of admission, patient demographics (age, gender) and reasons for admission, diagnosis and care pathway were analysed. Questionnaires were completed by a subgroup of 12 patients to assess satisfaction with care.
RESULTS: The mean age was 63.62 years with a range of 29-85 years. Thirty patients were 65 years or older. Lung, bowel, breast, prostate and oesophageal cancers were the most prevalent in terms of emergency admissions. Admissions were grouped into admission due to cancer progression (30/60), treatment-related reasons (20) or for other medical conditions (10). Specialist investigation or management was required by all. Twenty-nine patients were admitted to the Emergency Assessment Unit, 27 were admitted directly to the oncology ward and four patients were admitted through the Accident and Emergency Department. Three patients might have been more appropriately admitted to palliative care services. There was correlation with patient satisfaction and admission to the oncology ward rather than through the Emergency Assessment Unit first.
CONCLUSION: The cancer burden is increasing, with more patients with cancer being admitted as emergencies. Patients seem to favour continuity of care and admission to an oncology ward directly. Further research needs to be carried out in this area as to how best care may be achieved, taking into account local resources and the changes in practice that have come from continuing treatment much longer into the course of the disease. The organisation of healthcare services has to take account of patient preference to balance efficiency and patient satisfaction. Training in palliative oncology may need to be extended to other groups than oncologists.