Barriers to Inpatient Oncology Admissions in the Absence of an Emergency Department

Introduction

St John of God Subiaco Hospital (SJOGSH) is a tertiary hospital situated in Perth, Western Australia.  The hospital has a significant haematology/oncology service but does not have an emergency department (ED).  The service uses a nursing-lead telephone triage system to support patients with complications of their condition or therapy through which admissions to the Acute Admission Unit (AAU) may occur. Prior to the triage service patients were being admitted via multiple routes, including consultant rooms and on discussion with administration staff. There was an anecdotal view amongst consultants that this lack of patient assessment prior to presentation to the hospital resulted in patients often arriving very unwell, requiring activation of the medical emergency response (MER) team. Multiple routes of entering the hospital also made it difficult to keep a record of oncology patient admissions and monitor areas that require improvement. The triage phone service allowed a central area with readily available patient data, facilitating interrogation of this data to allow us to better understand barriers to admission and via this pathway to create a more streamlined process and enable less fragmentation of care by expanding our AAU.

Methods

This was a retrospective review of the triage call logs over a 3-month time period from September 1st 2022 to November 30th 2022

Results

Over the study period 142 calls were made to the triage service.  Of these calls;

The AAU operates between 0700 and 2130 each day.  We examined three different time slots during which the calls were made (Figure 1.);