Palliative outpatient hot clinic: Rapid access for oncology patients visiting emergency department in a tertiary hospital in Singapore—A 1-year experience.

Abstract

137 Background: Oncology patients often present with symptoms at Emergency Department (ED). While most patients require admission for further management, some patients can be discharged from ED with outpatient follow-up. However, most patients were given 4 to 6 week appointment. In the light of this service gap, our department collaborated with ED to facilitate rapid access to Palliative Outpatient Hot Clinic (POHC) within 3 working days from ED visit in 2015. Methods: We performed a retrospective review of all patients seen in the ED who satisfied the referral criteria to POHC. The time / date of ED visit and basic demographics of patients were collected. Various outcomes of POHC referral were documented using a pre-determined protocol. Results: 17 out of 68 (25%) patients who attended ED and referred to POHC were included. 11 (64.7%) patients were seen after-office hours. 12 (70.6%) patients were ≥ 60 years old, 14 (82.4%) were male, and 11 (64.7%) had Eastern Cooperation Oncology Group (ECOG) ≤ 2. Among them, 6 (35.3%) patients were known to Palliative Home Care Service and 5 (29.4%) patients were referred after-office hours. The most common oncological diagnosis was gastro-intestinal carcinoma (N=6; 35.3%). 8 (47.1%) patients were receiving oncological treatment. All patients were referred for poor symptom control [Pain (N = 8; 47.1%), dyspnoea (N = 5; 29.4%) and vomiting (N = 1; 5.9%)]. 10 (58.5%) patients were given an appointment with POHC within 3 days. 4 (23.5%), 7 (41.2%) and 10 (58.5%) patients were seen in POHC within 3, 7 and 30 days of ED visit respectively. Among 13 patients who were not seen within 3 days, 7 (53.8%) referrals were screened and rescheduled, 3 (23.1%) were readmitted to hospital; 2 (15.4%) requested to change appointment and 1 (7.7%) defaulted the appointment. 10 (58.5%) patients were eventually seen by POHC. Conclusions: Rapid access to POHC is vital in the partnership with ED to allow the seamless and timely provision of Palliative Care for Oncology patients.