Authors (including presenting author) :
Wong L (1), Suen TKD (1), Tsang TC (2), Lau YC (1), Tang YCF (1), Lo KY (2), Kwong A (1)
Affiliation :
(1) Department of Surgery, Queen Mary Hospital (2) Department of Accident and Emergency, Queen Mary Hospital
Introduction :
Quite a few patients with suspected or newly diagnosed breast cancer admitted to hospital via Emergency Department in Queen Mary Hospital (QMH). Some of them had no emergency medical issue to be managed at admission. Nurse-led telephone triage service was set up since November 2020 to avoid unnecessary admission and provide timely care.
Objectives :
Objectives: 1. Reduce unnecessary hospital admission for suspected or newly confirmed breast cancer patients from Emergency Department 2. Provide information on breast cancer diagnosis and treatment 3. Provide psychological support to decrease their anxiety
Methodology :
Methods: Logistics flow of avoiding unnecessary admission was confirmed between Breast Division of Department of Surgery and Emergency Department of QMH by the end of October 2020. The referral letter was faxed to Advanced Practice Nurse (APN) of breast team for triage. The follow-up appointment was arranged according to division triage protocol, further confirmed by breast surgeon. In the next working day, the breast care nurse (BCN) contacted the patient over the phone to explore their concerns, explain triple assessment of breast cancer, advise on breast imaging if not performed, and inform follow-up appointment. In addition, Priority 2 (P2) and Routine follow-up appointment slip was mailed to corresponding address. The contact of BCN was given for further enquiry.
Result & Outcome :
Result: A total of 48 patients (n=48) were referred to BCN from November 2020 to October 2021, with a mean age of 54 (Range 21-84). 83.3% patients (n=40) presented with a breast mass, and six of them the breast mass was fungating. 12.5% patients (n=6) presented as mastalgia, and 3.8% patients (n=2) presented as bloody nipple discharge. 44% patients (n=21) were domestic helpers from the Philippines or Indonesia. 2 of 21 domestic helpers performed breast imaging before attending Emergency Department. Only 29.1% patients (n=14) attended primary care for breast imaging and /or breast biopsy before admission to Emergency Department. 62.5% patients (n=30) were arranged as Priority 1 (P1) follow-up, 31.3% patients (n=15) were arranged as P2 follow-up, remaining 6% patients (n=3) were arranged as Routine follow-up. 8.3% patients (n=4) lost in contact after referral. Further appointment was mailed to corresponding address but they defaulted again. After telephone counseling, 20% patients previously scheduled P2 follow-up (n=3) performed breast imaging, were advanced to P1 follow-up. Conclusion: Nurse-led telephone triage service can effectively decrease unnecessary hospital admission by providing psychological support, and provide timely and appropriate care. However, public education on breast cancer diagnosis process, usage of primary care and referral logistics to specialty care should be strengthened in the community. In addition, education should be emphasized to domestic helpers for appropriate usage of Hong Kong health care system. Furthermore, advocating breast awareness is always the role of BCN in the future.
