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Ambulatory Care at Macmillan Cancer Centre, University College London Hospital

Ambulatory Care at Macmillan Cancer Centre, University College London Hospital. October 2015. Diana Comerford RGN Ambulatory Care Clinical Lead University College London Hospitals NHS Foundation Trust. What is Ambulatory Care (AC)?. An extension of inpatient services

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Ambulatory Care at Macmillan Cancer Centre, University College London Hospital

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  1. Ambulatory Care at Macmillan Cancer Centre, University College London Hospital October 2015 Diana Comerford RGN Ambulatory Care Clinical Lead University College London Hospitals NHS Foundation Trust

  2. What is Ambulatory Care (AC)? • An extension of inpatient services • Healthcare service without overnight hospital stay • Patients receive same treatment administered in inpatient setting • Reside at Cotton Rooms (UCLH Hotel), other local hotel, or at home • Patients attend AC daily for treatment or assessment, located next to Chemo Day Care service

  3. Brief History • Opened in 2005 with two side rooms and one Band 6 and one Band 7 nurse, treating two patients • 2 blocked inpatient beds • ESHAP mainly, conservative treatment • Local hotel with installed panic alarms • Cost pressure until proven safe • £130 hotel stay vs £700 per night hospital stay • Consultant buy in • Slowly increased capacity with demand

  4. AC at Present • 6 chairs+6 side rooms, 15-22 patients daily • 4 experienced haem/onc nurses • 1 potentially blocked inpatient bed • All white cell regimes w. exception of 1st AML cycle, or high risk relapse patients, sarcoma regimes • LEAM/BEAM/MelphalanAutograft • Low Intensity Allograft • Remain in AC if clinically well • No capacity at times

  5. AC Operational Management • Open from 0800-1900 • Electronic appointment system (FileMaker Pro) • Patients assessed daily by nurses using NCI CTC (2003) scoring system, obs., bloods, etc. • Nurse-Led service • Doctor review if required • Twice weekly ward round with Consultants • Patients/carers have 24hr access to AC mobile number for advice • Panic alarm installed in hotel rooms

  6. AC Operational Management • Hotel provides breakfast (+fridge, microwave in common area, tea/coffee making facilities, washer/dryer for clothes) • Food vouchers • One AC bed inpatient for emergencies • Aim for all admissions during AC operating hours

  7. Length of Stay Sample

  8. CADD Pumps Examples: • Cytarabine BD • Cisplatin • Foscarnet • IVH (mesna, sodium bicarbonate)

  9. AC Patient Eligibility Criteria • 25 years old and above (TYA service available) • Patient Consent • Patient or Carer must speak English • Those with limited mobility must have a carer • Mobile phone • Thermometer (provided by us) • Compliant with care and medications • Have an address to be discharged to

  10. AC at Home • Consultant agreement • Lives within 60 minute travel time • Carer available to drive patient • Live near local hospital (30-45 minutes) • Complexities of AC at Home • No parking • Missing ward rounds • Late night issues with infusion pumps

  11. House Rules • Must pick up phone at all times • Take own medication and temperature • Call if unwell, temperature, uncontrolled diarrhoea/nausea/vomiting • Show up on time

  12. Why Use AC? • Patient freedom and independence • Sense of control • Earlier discharge compared to inpatients • (data available) • Privacy • Better food choices • Valuable family time • Financial savings

  13. Safety Considerations • AC chat and sign • Who uses side rooms (allo/infectious patients) • Teaching of CADD pumps, spillage kits, CADD record of infusion • Who cares for patients out-of-hours? • 24 hour advice phone • Medical notes to ward

  14. Total AC Hospital Transfers n =116 • 13 Out-of-hours transfers to hospital (11%) • More than one factor/patient contributing to transfer • 5 major reasons for admission - febrile neutropenia - anxiety - GI symptoms - stem cell reaction - multiple infusion requirements

  15. Results:Reason for Hospital Admission N = 116

  16. Staff Experience • Continuity of care in an outpatient setting • New learning experiences • Experienced nurses with inpatient knowledge • Training nurses and a small service • Skill mix and staffing difficulties

  17. Patient and Carer Questionnaires • Empowering experience for patients / carers • Allows for formation of working partnerships with healthcare professionals • Opportunity to become more involved in care • ↑ in patient’s general morale • Allows for more ‘normality’

  18. What Next? • Merging haematology services with Royal Free NHS Trust • Increase chair and bed spaces (10+6) • Restructuring our diary and nursing team • Pushing for chemistry analyser specifically for Cancer Centre • Increase AC at home • Utilising UCLH at Home

  19. How AC could work for you? • AC at home • Utilising district nurses • Working with a primary care centre

  20. Questions?

  21. Contact details Diana Comerford Ambulatory care cancer services Univeristy College Hospital Macmillan Cancer Centre 2nd floor, Huntley Street London, WC1E 6AG +44 7946 535 703 diana.comerford@uclh.nhs.uk

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