Background
Cancer patients undergoing systemic anti-cancer therapies (SACT) invariably experience toxicities precipitating presentations to Emergency Departments (ED). With the ongoing COVID-19 pandemic, it is imperative to keep vulnerable immunocompromised patients out of hospital and encourage patients to contact SURC when symptoms develop. This nurse-led SURC model of care has been reported to achieve an investment return of $1.73 for every dollar invested. At Peninsula Health (PH), we recently established SURC supported by the Victorian Government and are evaluating its uptake and effectiveness.
Methodology
Episodes of care (Educations, phone, and physical attendances) occurring between 31/08/2020 to 30/06/2021 were captured in the SURC Access Database and analysed. ED presentations pre- and post-SURC commencement were examined if potentially avoidable presentations have reduced. Baseline patient experience and post SURC implementation surveys were conducted amongst patients and clinicians with local ethics approval.
Results
1923 SURC episodes of care were provided to 540 individuals (educations 28.2%, phone triage 63.3%, and attendances 8.5%). The commonest tumour stream was breast (23.0%), lung (20.1%) and colorectal (17.2%), closely aligning with the local cancer prevalence rates. Most frequent SURC contacts were for gastrointestinal symptoms (16.9%), pain management (9.5%), care-coordination (9.1%) and medication advice (6.5%). Notably, more than one-third indicated they would have done nothing (38.5%) or delayed seeking medical advice (10.9%) without SURC. During the first five months post-SURC commencement we observed a 47.0% decrease in avoidable presentations within SURC operation hours, and a 29.3% decrease in after-hours ED presentations. The results from the patient and clinician surveys will be updated at the meeting.
Conclusions
The SURC model of care is an invaluable resource to support cancer patients undergoing SACT which allows prompt access to specialist care while avoiding emergency presentations in the ambulatory setting. Resources permitting, it should be standard of care across all health services providing cancer care.