Lessons from a pandemic: An audit of acute medical oncology admissions during SARS-CoV-2 outbreak

Ni Choinin, A.; Allen, M.; Milewski, L.; Power, D. G.; Connolly, R. M.; Collins, D.; O'Reilly, S.; Bambury, R.

Background: In December 2019 a cluster of pneumonias, later identified as SARS-CoV-2 (CoV), were reported in China. The first case in Ireland was reported February 29th 2020. The first community acquired case in Ireland was reported March 5th. The World Health Organisation declared CoV a pandemic March 11th. Lockdown measures were implemented in Ireland March 27th. Cork University Hospital is a large acute hospital and a tertiary referral center for cancer care. We undertook an audit of unscheduled medical oncology admissions over a 3 month period with a view to assess the impact of CoV on the centre. Method(s): From 1st February to 30th April we audited unscheduled medical oncology admissions. Parameters included presenting time, location and complaint, CoV status and average length of hospital stay (aLOS). Data was organised into 3 phases: four week period prior to a confirmed case of CoV in Ireland (phase I), four week period from confirmed case to lockdown implementation (phase 2) and four week period during lockdown (phase 3). After the outbreak of CoV we developed a separate medical oncology assessment facility (AOS) with an admission pathway. A hospital CoV pathway (CoVp) for potential CoV cases was also implemented. Result(s): A total of 162 medical oncology patients had unscheduled admissions during this period. Over half (57%) were receiving anticancer systemic treatment. The most common presenting complaints were pain (21%), pyrexia (17%) and dyspnoea (14%). The underlying diagnosis was cancer-related in 51%, treatment-related toxicity in 10% and non-cancer related in 39%. One patient was CoV positive. Unscheduled hospital admissions, source of admission and aLOS are outlined in the Table. [Formula presented]. Conclusion(s): A reduction in aLOS and ED admissions was paralleled by increasing use of alternative pathways. Processes which facilitate urgent assessment of oncology patients in specialized units avoid ED attendance and accelerate discharge planning in the care of cancer patients in the face of a pandemic and beyond. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2020