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Bevan Exemplar Cohort 9 projects

Optimise SDEC (Same Day emergency care) for patients with metastatic bowel obstruction

Lauren Mills and Claire Gilfillan

Aneurin Bevan University Health Board

Metastatic Bowel Obstruction (MBO) can affect around fifteen percent of patients with cancer. A distressing complication of the disease which can be affected by complex decision making, thus affecting patient outcomes. Furthermore, the decision-making should be managed by a multi-disciplinary approach including that of surgical teams, oncology teams and palliative care teams

MBO is caused by secondary cancers within the area of the abdomen, for example; Bowel, stomach or even ovarian primary tumour sites. It is common in those with advanced cancer and as a side effect of surgical intervention or radiotherapy to the abdominal area. The gastro-intestinal tract is affected by bowel obstruction (BO), this, due to the absence or reduction of gastro-intestinal contents, and it’s inability to pass through.

Same Day Emergency Care (SDEC) in Aneurin Bevan Health Board (ABUHB) has significant potential to improve services for cancer patients that present as an emergency. Currently, however, there are no cancer pathways for use in SDEC, meaning use of the units is not optimal. This project will focus on a Metastatic bowel obstruction (MBO) pathway for cancer patients via SDEC and it is anticipated that it will reduce length of stay, enhance patient experience and improve outcomes.

MBO has been identified as a presenting complaint that can be dealt with in SDEC as opposed to admission.

In relation to bowel cancer patients, on average 26% are not for surgery and require appropriate supportive measure and return to their normal living arrangement. Around 42% of gynaecological cancer patients will present with a MBO and a stay in hospital can result in missed chemotherapy sessions and impaired outcomes.

Patients with MBO require a multi-disciplinary (MDT) approach across different health boards, and different specialties. When this is optimised through well supported integrated pathway it is anticipated that time to treatment decisions can be reduced, time in hospital reduced and outcomes improved.