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Ambulatory approach to cancer care. Part 3: starting and maintaining the service and its challenges and benefits

26 September 2019
Volume 28 · Issue 17


This is the final article in a three-part series. Previous articles discussed the patient experience and the enhanced roles of nurses and the multidisciplinary team (MDT) and their role in safety within ambulatory care (AC) at a major London teaching hospital. There is understandably apprehension when starting a new service and embarking on a new healthcare concept. The challenges of starting and maintaining an AC service are multifaceted. Common questions posed to this London teaching hospital concern the challenges of opening and maintaining a new service and the savings it will produce. There are many indirect savings and benefits to an ambulatory service, although the value of a positive patient experience cannot be measured in monetary terms.

The London teaching hospital (LTH) discussed in this article started an ambulatory care (AC) service in 2005. The patient experience of the service and the role of nurses and the multidisciplinary team and safety were discussed in parts 1 and 2 of this three-part series (Comerford and Shah, 2018; 2019).

Initially, two side rooms within the LTH's day care unit were used, plus one ring-fenced inpatient bed for every five patients. Two band 7 nurses joined the service on secondment. Thus this service was taken on as a cost pressure to the cancer service initially, owing to the increase in staffing. This had a minor impact on the clinical area. There was capacity for seven patients at this time. In 2012 the service moved to another building and gained its own area, comprising six chair spaces and six side rooms. The impact on other existing cancer services, such as the day care unit, was not measured because the whole cancer division was expanding. Figure 1 shows the trajectory of inpatient beds saved daily on average per financial year from 2006 to 2017 through the increase in capacity of the AC service since its inception.

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