Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Lessons learnt from implementation of an Oncology Nurse Practitioner-led Rapid Access Clinic Expansion (RACE) service at a tertiary regional cancer centre.  (#420)

Cassandra Dickens 1 , Manohan Sinnadurai 1 , Martina O'Neill 1 , Greg Cadigan 2 , Natalie Bradford 3 , Bryan A Chan 1 4
  1. Adem Crosby Centre, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
  2. Healthcare Improvement Unit, Queensland Health, Brisbane, Queensland, Australia
  3. Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia
  4. Griffith University, Nathan, Queensland, Australia

Background:  

Patients with cancer often require urgent assessment and intervention for complications related to their disease or treatment. Increasing numbers of patients and treatment complexity has added pressure to already strained hospital and primary care systems. To better assist our patients and prevent avoidable Emergency Department (ED) presentations, we implemented an Oncology Nurse-Practitioner (NP)-led, Rapid Access Clinic Expansion (RACE) service for telephone triage and streamlined outpatient management.  

Aims:  

To evaluate and describe pragmatic models and pitfalls to inform future models and service expansion.  

Methods:  

The RACE service was established in January 2023, as a NP-led service (Monday to Friday; 0830 to 1600hrs). Calls and referrals were assessed for service eligibility and triaged by a dedicated Clinical Nurse (CN), using the United Kingdom Oncology Nurses Society Oncology/Haematology Telephone Triage Tool.  Escalation pathways enabled the CN to seek advice or support from the NP, including urgent outpatient review. The implementation evaluation of RACE was informed by the ‘Reach, Effectiveness, Adoption, Implementation and Maintenance’ framework. 

Results 

From January to June 2023, 157 patients/carers utilised RACE. ED presentation was avoided in 134 (85%) patients, of these 127 (95%) were managed entirely as outpatients.  

Education and awareness of the RACE service and eligibility criteria was imperative for successful implementation. Service establishment challenges were related to sustainable workforce support. Staffing challenges arose in relation to recruitment into essential service roles and backfill. Despite these challenges RACE was able to manage clinical concerns and assist in the mitigation of ED and hospital presentations efficiently and safely, with 100% of patients expressing satisfaction. 

Conclusions 
Our RACE service demonstrates the importance of appropriate resourcing, training, and support for the successful implementation of a new service model. Specialist oncology NP-led services can reduce avoidable emergency presentations and admissions, whilst meeting the unplanned clinical needs of oncology patients.