Innovative care and hospital infrastructure models
- 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.1,2,3,4,5 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.3
- 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.8,9,10,11 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.7,12,13
- 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.14
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,15 and protecting the wellbeing of staff and immunocompromised patients.16
- Despite an additional administrative and technical burden, e-prescribing (where available) and e-ordering of investigations supports patient choice, quality and safety.17,18,19
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.
- Promoting deliberation in hospital design to include readily convertible spaces that consider flexible patient and staff flows through the hospital, to be responsive to current and future pandemics.
- Enabling the ongoing process of e-prescribing of medicines, such as through the progressive roll-out of the national Active Script List Model.19
- 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.20
- Adopting models of care that incorporate patient-reported outcomes, underpinned by ethical principles of equity, proportionality and transparency in resource allocation decisions.21,22
- 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.11
- 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.
- 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.
 Moujaess E, Kourie HR, Ghosn M. Cancer patients and research during COVID-19 pandemic: a systematic review of current evidence. Crit Rev Oncol Hematol. 2020;150:102972.
 Jazieh AR, Al Hadab A, Al Olayan A, et al. Managing oncology services during a major coronavirus outbreak: Lessons from the Saudi Arabia experience. JCO Glob Oncol. 2020;6:518-24.
 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;31(7):840-3.
 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;98(12):827-35.
 Mayor S. COVID-19: impact on cancer workforce and delivery of care. Lancet Oncol. 2020;21(5):633.
 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.
 National cancer expert or consumer participant. Cancer Australia COVID-19 Recovery and cancer roundtable. Meeting minutes unpublished. 30 July 2020.
 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;60(1):e5-e7.
 Multinational Association of Supportive Care in Cancer. Identifying patients at low risk for FN complications: development and validation of the MASCC risk index score [Unpublished]. 2015 [cited 2020 July]. MASCC Risk Index for Febrile Neutropenia available from: https://www.mdcalc.com/mascc-risk-index-febrile-neutropenia
 Segelov E, Underhill C, Prenen H, et al. Practical considerations for treating patients with cancer in the COVID-19 pandemic. JCO Oncol Pract. 2020;16(8):467-82.
 Underhill C, Parente P, McArthur G, et al. Towards new models of cancer care in Australia: lessons from Victoria's response to the COVID-19 pandemic. Int Med J. 2020;50(10):1282-5.
 National Health Service. Clinical guide for the management of cancer patients during the coronavirus pandemic 17 March 2020 Version 1. United Kingdom: NHS; 2020.
 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.
 Australian Government Department of Health. Coronavirus (COVID-19): National Health Plan resources. 2020 [cited 2020 September]. Available from: https://www.health.gov.au/resources/collections/coronavirus-covid-19-national-health-plan-resources.
 Asgari P, Jackson A, Bahramnezhad F. Resilient care of the patient with COVID-19 in Iran: a phenomenological study. 2020. doi: 10.21203/rs.3.rs-24733/v1.
 Weinkove R, McQuilten ZK, 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.
 Consumers Health Forum of Australia. Script change: electronic prescribing and consumers [webinar]. 2020. Available from: https://www.youtube.com/watch?v=VWq6CVHttac
 Australian Commission on Safety and Quality in Health Care. Electronic medication management systems - a guide to safe implementation (third edition). Sydney, NSW: Australian Commission on Safety and Quality in Health Care; 2019.
 Australian Digital Health Agency. Electronic prescriptions. 2020 [cited 2020 August]. Available from: https://www.digitalhealth.gov.au/initiatives-and-programs/electronic-prescriptions.
 Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards user guide for medication management in cancer care. Sydney, NSW: Australian Commission on Safety and Quality in Health Care; 2020.
 Medical Council of New Zealand. Safe practice in an environment of resource limitation. New Zealand: Medical Council of New Zealand; 2018. Available from: https://www.mcnz.org.nz/our-standards/current-standards/medical-care-and-prescribing/safe-practice-in-an-environment-of-resource-limitation/
 Australian Government Department of Health. Australian health sector emergency response plan for novel coronavirus (COVID-19). 2020 [cited 2020 August]. Available from: https://www.health.gov.au/resources/publications/australian-health-sector-emergency-response-plan-for-novel-coronavirus-covid-19.