Background: Chemotherapy is predominantly delivered to outpatients, toxicities may require emergency presentation leading to unplanned hospitalisation. Public hospitals face daily challenges balancing escalating demand against bed-capacity limits. Length-of-stay and unplanned re-admissions are common indicators of operational performance within hospitals. Studies suggest some hospitalisations related to adverse drug events may be preventable.
Aim: A prospective audit of oncology patient hospitalisations to identify unplanned admissions during chemotherapy.
Methods: A prospective audit of oncology patient hospitalisations over a 3-month period (Oct-Nov17) was undertaken by clinical pharmacists. The audit’s scope included; emergency and planned admissions and excluded admissions under other specialities unless transfer-of-care occurred. Patient demographics, cancer diagnosis/stage, reason for admission, current chemotherapy regimen, last treatment date and length-of-stay were recorded in a de-identified manner on an audit datasheet. The audit assessed whether the unplanned hospitalisation was potentially related to a chemotherapy adverse drug event.
Results: 579 outpatients received chemotherapy at Westmead hospital, 259 oncology patients were hospitalised during the audit period; 92 (35%) patients had an unplanned hospitalisations during chemotherapy . The most common cancer diagnosis within this group were early breast cancer (14.1%), non-small cell lung cancer (14.1%) and gynaecological cancers (12.0%). Infection (26.7%), pain (14.4%) and constipation (13.1%) were the primary reasons for unplanned hospitalisation. Oncology pharmacists clinically assessed infection and constipation to be potential adverse effects of chemotherapy.
Conclusions: Not all hospitalisations can be avoided or predicted in this group of patients. During this snapshot audit, more than a third of oncology admissions were unplanned hospitalisations during chemotherapy. Audits can help inform assessments of healthcare performance and highlight areas for improvement to reduce demands on inpatient beds. Pharmacist-led intervention strategies related to infection and constipation prevention will be explored. Monitoring of unplanned hospitalisation during chemotherapy can be streamlined with transition to digital health-systems.