Nurse-led interventions for cancer patients in emergency departments: Systematic review

Background: The Australian government introduced national emergency access targets in 2011 to improve emergency department efficiency. Innovative nursing models of care could achieve these targets with cancer patients, who often present to emergency departments with treatment-related toxicities and poorly-managed symptoms. Aim: To investigate whether national emergency access-like targets are achievable with interventions led by Advanced Practice Cancer Nurses when cancer patients attend Emergency Departments. Method: Authors searched electronic databases CINHAL, MEDLINE and Cochrane to July 2016. Outcomes included length of stay, adverse events, patient satisfaction, and cost effectiveness. Two reviewers independently conducted data extraction and risk of bias assessment using standard Cochrane methodology. Results: Of the 579 titles retrieved, six randomised control trials met identified eligibility criteria. Nurse-led interventions significantly reduced emergency departments’ length of stay in two studies and improved patient satisfaction in two studies without affecting mortality, readmission and re-examination. Cost data could not be translated to the Australian context because of different salary scales and funding models. Discussion: This review did not identify investigations of any nurse-led interventions to improve national emergency access-like targets in presenting cancer patients. While it is unclear if Advanced Practice Cancer Nurses can treat cancer patients more efficiently as standard care, there is some indication that Advanced Practice Cancer Nurses might be able to deliver improved length of stay for cancer patients in emergency departments. Conclusion: Rigorous research is needed to implement and evaluate this role at the interface of the emergency departments and the cancer setting.