Introduction A significant proportion of lung cancer patients present as an emergency. This is associated with poor one year survival. Many of these patients have had contact with health services before presenting as an emergency. It is estimated that one in five lung cancer patients have an unplanned admission before their urgent clinic appointment.¹

Objective To reduce the number of emergency lung cancer admissions by providing an effective alternative ambulatory pathway for high risk patients.

Methods Patients referred on the two week wait pathway are vetted by the respiratory physicians. Those identified as having a high risk of admission are prioritised and reviewed urgently on the ambulatory care unit usually by the next working day. Patients with the following features were expedited:

1. Superior vena caval obstruction

2. Liver function abnormalities

3. Large tumour burden on chest radiograph

4. Severe symptoms such as pain and breathlessness

5. Large pleural effusion.

Patients with suspected lung cancer presenting to the emergency department were also re-directed to the ambulatory care unit whenever feasible. We evaluated the service for a period of 12 months from October 2014 and compared it with the 12 month period prior to the commissioning of the ambulatory care unit in June 2013. As part of the service, the team developed an innovative lung cancer diagnostic service utilising ultrasound guidance to facilitate early diagnosis.

Results Table 1 demonstrates the resulting drop in unplanned lung cancer admissions and length of stay. We estimate a cost saving of £170,000 based on a 710 bed-day reduction (£300/bed day) after taking into consideration physician time. If rolled out nationally, reducing the admission rate to 34% of the lung cancer incidence will avoid 6800 admissions (>55,000 bed-days) with significant cost savings and benefits to patients.

Conclusion Flexible pathways are cost effective and prevent emergency admission of lung cancer patients which is associated with high mortality. This novel approach is easily adoptable widely and would have a significant impact across NHS.

Reference

1. Tackling emergency presentation of lung cancer: an expert working group report and recommendations. British Lung Foundation, 2015.