Authors (including presenting author) :
Chan KK(1), Yu KS(1), Chan SH(1), Fung CHL(1), Yeung SKD(1), Tang LL(2), Chan SY(1), Chan SM(1), Ling WM(1), Wu PY(1)
Affiliation :
(1)Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, (2)Department of Medicine, United Christian Hospital
Introduction :
Metastatic Spinal Cord Compression (MSCC) is an oncological emergency which can cause irreversible neurological damage, significant medical complications and adverse impact on quality of life. Early diagnosis and intervention could mitigate these negative effects.
A small cases review performed on six oncology inpatients with MSCC from January 2018 to June 2019 revealed that their length of stay tended to be long. Delayed initiation of multidisciplinary supportive care and mobilization, and absence of routine psychosocial assessment were also detected. The lack of a systematic and timely multidisciplinary care plan for patients with MSCC was evident.
Objectives :
To enhance the quality of care for MSCC by establishing and implementing a systematic multidisciplinary care pathway in clinical oncology wards.
Methodology :
Based on the gaps identified from the aforesaid review and current international guidelines, a departmental integrated care pathway for MSCC was developed. Emphasis is placed on the multidisciplinary input for timely therapeutic intervention, pain management, psychosocial care, and supportive measures to maximise rehabilitation, prevent medical complications and aid discharge planning. To facilitate the implementation and systematic service delivery, a clinical practice checklist was developed and used since September 2019. A clinical audit was conducted in late 2020 to evaluate its effectiveness.
Result & Outcome :
Twenty-one patients from September 2018 to August 2019 (pre cohort) and forty patients from September 2019 to August 2020 (post cohort) were recruited for the audit. Comparing the 2 cohorts, the median length of stay was shortened from 13 to 11 days. The median lapse of time for the multidisciplinary team referral was reduced from 3 to 2 days. This referral was made for all the post cohort patients, but 9.5% was missed in the pre cohort. Moreover, all the post cohort patients received psychosocial and dietetic consultations, and regular pain assessment. The implementation was smooth and well received by front-line staff.
Conclusion:
MSCC is a complex and debilitating condition that requires the effort of a multidisciplinary team. An integrated care pathway promotes systematic, timely and holistic care delivery, and is worthwhile to adopt in routine practice.
