Core – Acute oncology

This is designed to capture Acute Oncology (AO) episodes within a Trust.

The purpose of these items is to capture the unplanned care cancer patients receive in an Acute care environment. These data are only for collection by those Hospitals with an Acute Oncology Service (AOS) in place.

Key Objectives for collecting AO data within COSD:

• gather data on the unplanned care provided to cancer patients
• use the data to generate benchmarks and report against metrics
• identify new standards of care for cancer patients requiring emergency care or specialised support

To support the local, regional, and national reporting against these key objectives, the below data items have been identified:

May be multiple occurrences per record (0..*)

Start of repeating item - Patient type

End of repeating item - Patient type

This information has been selected specifically because it is commonly collected by AO teams and the collation of these few data items with other nationally collected datasets such as Hospital Episode Statistics (HES), Emergency Care Data Set (ECDS), Systemic Anti-Cancer Therapy (SACT) will provide a view of the unplanned care provided to cancer patients.

Please note the rules have changed for COSD v10, and the assessments can be telephone or face to face and carried out by the AOS or staff trained by the AOS to provide appropriate levels of care and decision making.

Each assessment that takes place during a patient’s AO episode should be reported as an individual record, even if the assessments share the same date and Outcome; it is important all data is completed for each assessment to capture all the activity for each episode.

Details about the individual data items and their value lists follow below.

Acute Oncology Assessment Date

This is the date the oncology assessment was carried out.

Additional supporting information includes:

• if more than one assessment has taken place during the AO episode, supply the date of each assessment, along with all the additional data items laid out below, including the Outcome
• include AO assessments carried out by AOS and other medical staff trained to provide AO care (who may not be members of the AOS)

Organisation Site Identifier (Acute Oncology)

This is the ‘Organisation Identifier of the organisation acting as a Health Care Provider.

Additional supporting information includes:

• this data item will identify the location of the hospital or cancer treatment centre in which the patient was assessed
• the 5 digit hospital-specific code of where the assessment took place must be recorded rather than the 3 digit Trust level code

Assessment Location

This is the location where the Acute Oncology (AO) assessment was performed within the health care provider.

Notes:

• ‘98 – Other’ has been replaced with ‘97 – Other’, as per Data Dictionary guidelines
• 09 and 10 are new choices in v10

The assessment location will generally be one of the above, or similarly named – select the closest match or ‘Other’ if none of them fit.

Additional supporting information includes the following:

01 - Emergency Care Department:

• this would be selected if the patient was in an emergency care department chair or bed, admitted or not, when the AOS assessment was carried out

02 - Medical Assessment Unit:

• this would be selected if the patient was in a Medical Assessment Unit chair or bed, admitted or not, when the AOS assessment was carried out

03 - Emergency Ambulatory Care Unit:

• this would be selected if the patient was assessed in an Ambulatory Care unit when the AOS assessment was carried out

04 - Ward:

• this would be selected if it was the most appropriate selection given the other options available for where the AOS assessment was carried out

05 - Out-Patient Clinic:

• this would be selected if it was the most appropriate selection given the other options available for where the AOS assessment was carried out

06 - Dedicated Acute Oncology Bed/Chair:

• this would be selected if the patient was assessed whilst in a dedicated AO bed or chair – admitted or not, when the AOS assessment was carried out

07 - Day Case Unit:

• this would be selected if it was the most appropriate selection given the other options available for where the AOS assessment was carried out

08 - Chemotherapy Unit:

• this would be selected if it was the most appropriate selection to make given the other options available for where the AOS assessment was carried out, inpatient or not

09 - Health Care Provider Telephone Assessment:

• this would be selected for telephone assessments carried out as part of the AOS patient management, regardless of whether the patient is asked to attend for a face-to-face assessment or not
  • for example, the whole episode may be handled via telephone
• however, if preferred, the assessments included in the COSD submission could be limited to only those telephone assessments carried out prior to advising a patient to come in for a face-to-face assessment or as part of the follow-up calls prior to discharging a patient from the AOS
  • the choice will be up to each AOS based on what makes most sense to their service set up, who handles the telephone assessments and where the data is recorded

10 - Radiotherapy Department:

• this would be selected if it was the most appropriate selection to make

98 - Other:

• this would be selected if none of the other options were appropriate

Patient Type

Record the type each patient presentation is grouped within.

Notes:

• ’05’, ‘06’ and ‘07’ have been deleted as the Information can be more accurately linked by analysts using the whole COSD record
• multiple selections can be made if more than one option fits

Use the below Guidance on how to record Patient Types to support your choices. We acknowledge it is not always clear whether a patient is presenting with treatment or cancer related complications, and we appreciate that it is unlikely the initial choice(s) made will be updated retrospectively.

The above list of options can be mapped to the below Patient Groups, which may be more familiar to you:

• Type I - all patients in whom a first diagnosis of cancer is suspected in the emergency setting
• Type II - patient with known cancer who present as an emergency with acute complications of non-surgical treatment, including Systemic Anti-Cancer Therapy (SACT) or radiotherapy
• Type IIIa - patients with known cancer and are acutely ill because of the disease itself; this group represent the largest proportion of emergency patients and often present with complex issues including comorbidity, progressive cancer, and end of life care (EOL) needs
• Type IIIb - patient with known cancer and are acutely ill because of comorbidity

See below table for mapping between the data item values and the Type I, II and III patient groups.

The Comorbidity Complication and Other patients will help establish the volume of patients who are assessed by AOS but do not actually have a specific cancer related issue at that time.

Interpretation

01 - New Presentation (Type I):

• this option is relevant for patients who have never had a cancer diagnosis before and who are diagnosed for the first time after an emergency attendance
• because these patients will not have an existing cancer record, an eligible cancer record will need to be created to enable the reporting of the AO data items
• we acknowledge there will be some AOS activity that cannot be reported via the COSD because the patient is confirmed with a non-cancer diagnosis

02 - Treatment Complication (Type II):

• this option is relevant for patients who have received or are receiving cancer treatment and consequently, have become poorly
• this could include patients who have an acute or chronic response to treatment, for example, patients who have an AO episode for acute SACT or Radiotherapy reactions or have a chronic condition caused by historic cancer treatment which has left them with directly related health complications

03 - Suspected or Confirmed Neutropenic Sepsis (Type II)

• although this could come under Treatment Complication it has been split out to capture any patients with an AO episode that started off as a suspected or concluded as a confirmed case of Neutropenic Sepsis/Febrile Neutropenia
• these data are intended to establish a national picture of the number of suspected NS cases in England

04 - Cancer Complication (Type IIIa)

• this option is relevant for patients who have become poorly because of their cancer rather than because of the treatment they are receiving
• these patients could have a current diagnosed cancer and are on active treatment or monitoring or patients who have an historic diagnosis

08 - Suspected or Confirmed MSCC (could be Type I or Type IIIa)

• this option is for patients who are suspected of having Metastatic Spinal Cord Compression (MSCC) and should be recorded as such regardless of whether the diagnosis is confirmed
• MSCC patients could also be New Diagnosis, or Cancer Complication but it has been separated out so analysis can be carried out on the number of MSCC patients in England

09 - Comorbidity Complications (Type IIIb)

• this option is for patients who present with comorbidity complications for example, heart disease or diabetes, and receive an AOS assessment
• it is important to gather data on these patients to assess the volume of AOS activity

98 – Other

• this option covers patients who have an emergency presentation for a reason unrelated to their diagnosed cancer, treatment, or comorbidity, for example, a broken bone - this data is not essential but would again help identify the volume of AOS activity

Outcome

Record the outcome of the acute oncology episode.

Notes:

• ‘8 – Other’ has been replaced with ‘98 – Other’, as per Data Dictionary guidelines
• all National Codes have been updated to improve the accuracy of data collection
• 13 has been renamed ‘Discharged from hospital’
• 15, 16, 17 and 18 are new choices in v10
• a new format ‘an2’ has been added to accommodate above changes

This information will generally be captured in the local PAS or Emergency Department system or dedicated AOS system.

These data will help with admission avoidance and length of stay calculations and focuses on the outcome of the interaction, rather than the outcome on the patient’s overall condition. Patient Died has been included to cover all potential outcomes.

Interpretation

Not Admitted:

• this option would be selected if the patient was not admitted to hospital and was sent to their usual place of residence or other location after being assessed by the AOS
  • this data will be used in the SDEC calculations
• this option is also relevant if the patient was assessed by an AOS who then referred the patient to another Organisation’s AOS
  • the second AOS may record their own assessment record(s) for their encounter with the patient

11 - Admitted:

• this option would be selected if the patient was assessed by AOS and admitted either on their recommendation or in consultation with relevant Acute Medicine staff

12 - Remained Admitted:

• this option would be selected if the patient was already an admitted patient before their AOS assessment and continued as an admitted patient after assessment with no recommendation by AOS to be discharged

13 - Discharged from hospital:

• this option would be selected if the patient was already an admitted patient before their AOS assessment and AOS recommended the patient was discharged after assessment
• if this data is not routinely collected by AOS, it will be available in the Hospital Episodes submissions (HES) dataset once the COSD data is curated at national level. This data is used in Length of Stay calculations

14 - Patient Died:

• this option would be selected if the patient died during their AO episode whilst onsite at the Hospital, regardless of whether they had been an admitted patient or not
• if this information is not routinely collected by AOS, it will be available in the ONS dataset once the COSD data is curated at national level

15 - Advised to attend for assessment

• this option would be selected if the patient had a telephone assessment and was advised to come into the Hospital for assessment by a member of the AOS or appropriately trained Medical Staff

16 - Discharged from acute oncology service (AOS)

• this option would be selected if the patient had a telephone or face to face assessment and it was agreed with the appropriate service or patient that AOS involvement was no longer necessary

17 - Discharged to specialist centre

• this option would be selected if the patient had been admitted to hospital and then discharged to a specialist centre
• an AOS at this new specialist centre may also assess the patient and record their own assessment record(s) for their encounter with the patient

18 - Telephone Assessment

• this option would be selected if a Telephone Assessment was planned as a follow up to either a face to face or telephone assessment, for example, the Outcome is to hold another Telephone Assessment with the patient, prior to discharging the patient from the AOS

98 - Other:

• this option has changed from ‘97 – Other’ to ‘98 – Other’ and no longer covers ‘Discharged from hospital’, ‘Advised to attend for assessment’, ‘Discharged from acute oncology service (AOS)’, ‘Discharged to specialist centre’ or ‘Telephone Assessment’ as these are now choices
• this option covers all outcomes not listed in the above

This section provides examples of Acute Oncology assessment pathways.

Triage Line Assessment and Advised to Attend Emergency Department

In this example, the patient is assessed via the telephone and advised to come into hospital for assessment. The AOS advise an overnight stay with continued AOS involvement. AOS advise the Ward team the patient can be discharged from hospital with AOS follow up via the telephone until discharged from the AOS.

Same Day Emergency Care (SDEC)

In this example a patient attends Hospital without prior contact with an AOS, is assessed by an AOS on the same day and AOS advise patient returns to their usual place of residence and managed via telephone with, for example, a fast-tracked outpatient appointment in place.

Discharged to a Specialist Centre

In this example, the patient attends an ED without previous contact with an AOS telephone line and the ED assess, admit, and alerts AOS, who assess the patient and advise they remain admitted but need to be transferred to a specialist centre for ongoing care. Using the Discharge to Specialist Centre infers the patient is discharged from hospital and AOS. The AOS at the specialist centre may record their own encounter with the patient.

Inpatient Assessment

In this example a patient is an inpatient prior to referral to the AOS and remains admitted throughout the AOS encounter.

The following flow chart helps identify which Organisation is responsible for submitting the AOS data to the Registry. This acknowledges that AOS see patients whose cancer care is or has been provided by other Health Care Providers in the region or country.

For AOS data to be included in a COSD submission, it needs to be linked to an eligible cancer record, for example, a registerable cancer condition.

If your Organisation has, is or will be the Health Care Provider for the patient, the AOS data you collect can be included in the monthly submission your Organisation sends to the Registry.

If you would like your AOS encounter data to be submitted to the registry, but your Organisation does/will not have an eligible cancer record to link the AOS data to, you can send the data to the Health Care Provider responsible for submitting the patient’s COSD file and they can link the data to their cancer record and submit it on your behalf; this will build the picture of overall AOS activity across your region and nationally.

It does not matter whether the patient’s cancer care is historic, current, or planned – the AOS encounter data should stimulate the submission of the patient’s original COSD file to the Registry, with the AOS and any other new data included.

AOS Patient and Data Flow

The flow chart (below) starts with an assumption that the AOS Organisation will provide the patient’s cancer care (Health Care Provider) - if the patient is referred to another Organisation for management, they will be responsible for creating records and submitting the AOS data.

The final two steps in the flow chart indicate if a patient should be on a non-primary patient pathway (see non-Primary pathway details in this User Guide) and whether the AO data items will form part of a cancer record your Organisation is responsible for submitting or if you need to send it to another Health Care Provider so they can submit it on your behalf.

The text from the flowchart follows the image.

Step 1: the patient is seen by AOS.

Is the patient known to Cancer Services? 

If yes: update patient cancer record.

If no, step 2: is this a new cancer diagnosis?

If yes: create a new cancer referral.

If no, step 3: is the patient on a non-primary pathway?

If yes: create a new non-primary cancer referral.

If no: send AO encounter details to Provider overseeing the cancer care.