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Innovative care and hospital infrastructure models

Innovative care and hospital infrastructure models

What changed?

  • Internationally, the COVID-19 pandemic has increased focus on health system organisation, highlighting the importance for hospital designs to accommodate for spaces that are readily convertible for different purposes, such as an additional intensive care unit or oncological treatment wards, and consider staff and patient flows through the hospital.1,2,3,4 Hospital designs need to account for the separation of areas into COVID-19-positive and COVID-19-clear spaces.3
  • The pandemic also saw the establishment of temporary spaces for cancer treatment,5 the implementation of hub-and-spoke models for cancer centres, and synergising of public and private institutions.6,7
  • Some institutions adopted ‘segregated-team’ models to minimise the risk of COVID-19 infection and cross-contamination between teams.8
  • Novel triage protocols facilitated by telehealth and nurse-led models were also adopted for COVID-19 symptom review and for patients with treatment-related toxicities.9,10,11,12 These measures enabled assessment of patient needs for hospital care and helped to determine the required frequency of home visits.
  • Use of granulocyte colony stimulating factor (G-CSF) with chemotherapy regimens to reduce the risk of febrile neutropenia and outpatient treatment of low-risk patients with febrile neutropenia with oral antibiotics helped to reduce hospital admission rates.7,13,14 
  • Some health practitioners across Australia moved towards e-prescribing and e-ordering of investigations, enabled through the availability of telehealth and home delivery of medications.15

Impact of change

  • Implementation of innovative hospital and infrastructure models aiming to minimise potential overloading of acute care facilities, reducing community transmission by minimising and redirecting the movement of people through medical facilities,16 and protecting the wellbeing of staff and immunocompromised patients.17
  • Despite an additional administrative and technical burden, e-prescribing (where available) and e-ordering of investigations supports patient choice, quality and safety.18,19

How can high-value changes be embedded or enhanced?

The following strategies were identified in Australian and international literature and by leading Australian cancer experts and consumers. This list is provided to prompt considerations and future strategies to support high-value cancer care in the Recovery phases of the COVID-19 pandemic. 

These strategies are listed at the system-, service-, practitioner-, and patient-levels and are intended to be used by a range of cancer control stakeholders across Australia to support high-value cancer care and improve outcomes for people with cancer.

System-level strategies

  • Promoting greater deliberation in the design of future hospitals to include readily-convertible spaces that consider flexible patient and staff flows through the hospital. 
  • Enabling the ongoing process of e-prescribing of medicines, such as through the progressive roll-out of the national Active Script List Model.20

Service-level strategies

  • Implementing software and embedding of e-prescriptions and e-ordering of investigations within existing workflows, supported by change management, to enable consistent and ongoing patient access.21
  • Adopting models of care that incorporate patient-reported outcomes to support risk prioritisation, with consideration of ethical principles of equity, proportionality and transparency in their application to resource allocation decisions.22,23
  • Establishing new models of care, such as nurse-led Symptom and Urgent Review clinics within oncology outpatient units and Community Cancer Centres to keep immunosuppressed patients out of emergency departments and away from hospitals as much as possible.12

Practitioner-level strategies

  • Developing and promoting educational and training programs and guidance for health professionals to increase acceptance of and skills in delivering new models of care, including outpatient and home-based oncological care. This includes increasing confidence in staff capabilities in using telehealth; e-prescribing (particularly for therapies not usually prescribed by community pharmacists, such as oral chemotherapy agents) and e-ordering investigations; and in nurse-led models of care. 

Patient-level strategies

  • Developing and promoting consumer information and disseminating through relevant channels, such as via pharmacists, on the process of e-prescribing.
  • Educating patients and their carers to increase awareness and promote acceptance of new models of care.

 

References

[1] Moujaess E, Kourie HR and Ghosn M. Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence. Crit Rev Oncol Hematol. 2020;150:102972. 

[2] Jazieh A-R, Al Hadab A, Al Olayan A, et al. Managing oncology services during a major coronavirus outbreak: lessons from the Saudi Arabia experience. J Glob Oncol. 2020;6:518-24. 

[3] Ngoi N, Lim J, Ow S, et al. A segregated-team model to maintain cancer care during the COVID-19 outbreak at an academic center in Singapore. Ann Oncol. 2020; 

[4] Tuech JJ, Gangloff A, Di Fiore F et al. The Day after Tomorrow: How Should We Address Health System Organization to Treat Cancer Patients after the Peak of the COVID-19 Epidemic? Oncol. 2020 Jul 17;1-9. doi: 10.1159/000509650. 

[5] Mayor S. COVID-19: impact on cancer workforce and delivery of care. 21(5):P633. 

[6] Trapani D, Marra A, Curigliano G. The experience on coronavirus disease 2019 and cancer from an oncology hub institution in Milan, Lombardy Region. Eur J Cancer. 2020; 132: 199–206. 

[7] National cancer expert or consumer participant, Cancer Australia COVID-19 Recovery and cancer roundtable. Meeting minutes unpublished. 30 June 2020. 

[8] The National University Cancer Institute of Singapore (NCIS) Workflow Team. A segregated-team model to maintain cancer care during the COVID-19 outbreak at an academic center in Singapore. Ann Oncol. 2020 Jul; 31(7): 840–843. 

[9] Porzio G. Cortellini A, Bruera E et al. Home Care for Cancer Patients During COVID-19 Pandemic: The Double Triage Protocol. J Pain Symptom Manage. 2020 Jul; 60(1): e5–e7. 

[10] MASCC. Identifying Patients at Low Risk for FN Complications: Development and Validation of the MASCC Risk Index Score. Accessed: July 2020; https://www.mascc.org/mascc-fn-risk-index-score 

[11] Segelov E, Underhill C, Prenen H, et al. Practical Considerations for Treating Patients With Cancer in the COVID-19 Pandemic. JCO Oncol Pract. 2020 May 13;OP2000229. doi: 10.1200/OP.20.00229. 

[12] Underhill C, Parente P, Mcarthur G et al. Towards new models of cancer care in Australia: lessons from Victoria’s response in the COVID-19 pandemic. J Int Med. Forthcoming 2020. 

[13] National Health Service. Clinical guide for the management of cancer patients during the coronavirus pandemic 17 March 2020 Version 1. NHS, United Kingdom, 2020. 

[14] Freifeld AG, Sepkowitz KA. No Place Like Home? Outpatient Management of Patients With Febrile Neutropenia and Low Risk. J Clin Oncol. 2011. 29:30, 3952-4. 

[15] Department of Health. Coronavirus (COVID-19): National Health Plan resources. Accessed: September 2020; https://www.health.gov.au/resources/collections/coronavirus-covid-19-national-health-plan-resources 

[16] Asgari P, Jackson AC, Bahramnezhad F. Resilient care of the patient with COVID-19 in Iran: A phenomenological Study. 2020. doi: 10.21203/rs.3.rs-24733/v1 

[17] Weinkove R, McQuilten Z, Adler J et al. Managing haematology and oncology patients during the COVID-19 pandemic: interim consensus guidance. Med J Aust 2020; 212 (10): 481-9. 

[18] Consumers Health Forum of Australia. Script change: electronic prescribing and consumers [webinar]. Accessed: July 2020; https://www.youtube.com/watch?v=VWq6CVHttac 

[19] Australian Commission on Safety and Quality in Health Care. Electronic Medication Management Systems - A guide to safe implementation (third edition). ACSQHC, Sydney, 2019. 

[20] Australian Digital Health Agency (ADHA). Electronic prescriptions. Accessed August 2020; https://www.digitalhealth.gov.au/get-started-with-digital-health/electronic-prescriptions 

[21] Australian Commission on Safety and Quality in Health Care. Guide for clinicians: medication management in cancer care. Sydney: ACSQHC; 2020. 

[22] Medical Council of New Zealand. Safe practice in an environment of resource limitation. Accessed: August 2020; https://www.mcnz.org.nz/our-standards/current-standards/medical-care-and-prescribing/safe-practice-in-an-environment-of-resource-limitation/

[23] Australian Government Department of Health. Australian health sector emergency response plan for novel coronavirus (COVID-19). Accessed: August 2020; https://www.health.gov.au/resources/publications/australian-health-sector-emergency-response-plan-for-novel-coronavirus-covid-19