PTU-249 Key worker alerts in emergency admissions of patients with gastrointestinal cancer substantially shorten length of stay and readmission rates

Abstract

Introduction: A retrospective audit of data from 2007 to 2009 revealed that patients known to have gastrointestinal (GI) cancer admitted as an emergency to our trust had long median length of stays (LOS) of 13 days, despite coding in 80% indicating no procedural intervention was undertaken or limited to diagnostic testing. 50% of such GI cancer patients were admitted for symptom management or disease progression and only 18% had documented interaction with their key worker (clinical nurse specialist) during their admission. Methods: A pilot study of alerting the patient's key worker, when a patient known to have GI cancer was admitted as an emergency, was organised to establish whether early key worker intervention could shorten LOS and lower 30-day re-admission rates. Patients with GI cancer were flagged on Lorenzo (IPM) and an email and text message to the key worker generated via an ADT HL7 message to the Rhapsody Interface Engine, when a GI cancer patient was admitted as an emergency. The study initially involved patients with colorectal cancer but patients with upper GI cancer were also subsequently included. Results: During the 10-month study period, 146 colorectal alerts were received, 52 related to the patient's cancer, and during 8 months 57 upper GI cancer alerts were received, 42 related to the patient's cancer. Key worker intervention reduced LOS for colorectal patients admitted as an emergency from a median of 13 to 2 days and upper GI cancer from 7 to 1 day. Re-admittance rates were reduced from 28 to 8% for colorectal cancer patients and 35 to 23% for upper GI cancer. The principal interventions undertaken included symptom control and referral to specialist palliative care teams. Projections for 2011/2012 suggest that key worker alerts for GI cancer emergency admissions based on 260 colorectal and 146 upper GI cancer emergency admissions will save 3654 bed days. Conclusion: Key worker alerts are an inexpensive intervention that shortens LOS, prevents re-admission, does not adversely affect key worker workload and improves patient experience. The system has obvious potential benefits for patients with other cancer sites and patients with inflammatory bowel disease admitted as an emergency.