Northern Sydney Local Health District, Royal North Shore Hospital, University of Technology Sydney , Reserve Road, St Leonards, Sydney, New South Wales, 2065, Australia.
Support Care Cancer. 2020 Oct;28(10):5023-5029. doi: 10.1007/s00520-019-05292-0. Epub 2020 Feb 10.
In Australia, the number of cancer cases has doubled since 1991 and is the second most common cause of death as reported by Chen, H., et al. (Supportive Care in Cancer, 2018. 27: p. 451-460). Chemotherapy, a common treatment, is known to cause distressing symptoms that often lead to a person presenting to an emergency department (ED). The aim of this study was to investigate whether a nurse practitioner (NP)-led model of care could improve cancer service integration and reduce hospital presentations.
This was an evaluation study for a new model of care that included (i) telephone helpline; (ii) urgent assessment clinic; and (iii) rapid day treatment consultation service.
The utilisation rate was 337 telephone calls involving 157 patients in the 7-month pilot. The most common reason for calling the helpline was for symptom management (n = 173, 51%), followed by education regarding treatment (n = 61, 18%). As a result, 49% (n = 165) of callers were given advice, information, or education; 22% (n = 74) were referred on to other healthcare providers; and 11% (38) were admitted to hospital. Of the 38 admitted patients, 9 were admitted directly from the urgent NP-led clinic bypassing the ED.
The implementation of the NP-led model of care has reduced ED presentations, optimised symptom management, and streamlined patient telephone enquiries using validated clinical assessment tools (Jones 2018) within cancer services. The telephone helpline was available for the broader local health district community and was actively utilised. Patient surveys were overwhelmingly positive. The model of care has improved symptom management for patients and reduced ED workload and presentation rates.
在澳大利亚，自 1991 年以来，癌症病例数量增加了一倍，是 Chen，H.等人报道的第二大常见死因。（支持性护理癌症，2018 年。27：p.451-460）。化疗是一种常见的治疗方法，已知会引起令人痛苦的症状，这些症状通常导致患者到急诊部门就诊。本研究的目的是调查护士从业者（NP）领导的护理模式是否可以改善癌症服务的整合并减少医院就诊次数。
这是一种新的护理模式的评估研究，包括（i）电话热线；（ii）紧急评估诊所；和（iii）快速日间治疗咨询服务。
在 7 个月的试点中，有 337 个电话涉及 157 名患者，利用率为 337 个电话。拨打热线的最常见原因是症状管理（n=173，51%），其次是治疗教育（n=61，18%）。结果，49%（n=165）的来电者获得了建议、信息或教育；22%（n=74）被转介给其他医疗保健提供者；11%（38）住院。在 38 名住院患者中，有 9 名直接从紧急 NP 领导的诊所入院，绕过了急诊室。
NP 领导的护理模式的实施通过在癌症服务中使用经过验证的临床评估工具（Jones 2018），减少了 ED 就诊次数，优化了症状管理，并简化了患者的电话查询。电话热线可供更广泛的当地卫生区社区使用，并得到了积极利用。患者调查的反馈非常积极。该护理模式改善了患者的症状管理，并减少了 ED 的工作量和就诊率。
