Hotel-based ambulatory care for complex cancer patients: a review of the University College London Hospital experience

Abstract

Since 2005, University College London Hospital (UCLH) has operated a hotel-based Ambulatory Care Unit (ACU) for hematology and oncology patients requiring intensive chemotherapy regimens and hematopoietic stem cell transplants. Between January 2005 and 2011 there were 1443 patient episodes, totaling 9126 patient days, with increasing use over the 6-year period. These were predominantly for hematological malignancy (82%) and sarcoma (17%). Median length of stay was 5 days (range 1-42), varying according to treatment. Clinical review and treatment was provided in the ACU, with patients staying in a local hotel at the hospital's expense. Admission to the inpatient ward was arranged as required, and there was close liaison with the inpatient team to preempt emergency admissions. Of the 523 unscheduled admissions, 87% occurred during working hours. An ACU/hotel-based treatment model can be safely used for a wide variety of cancers and treatments, expanding hospital treatment capacity, and freeing up inpatient beds for those patients requiring them.

Systematic patient involvement for homebased outpatient administration of complex chemotherapy in acute leukemia and lymphoma

“…Prolonged hospital care is indeed being challenged by novel homecare and outpatient management interventions predominantly triggered by prospects of improving quality of life by reducing hospital admission and overall hospital costs (Kern, ; Sive et al , ). Our data confirm the experience from UCLH (Sive et al , ) and push to a new technology‐based development of outpatient acute leukaemia and HSCT management without compromising patient safety. With this setup, our department has been able to reduce the number of in‐ward beds with 10%, despite our increasing number of especially elderly patients.…”

“…Ambulatory infusion pumps were used to provide infusions including hydration for various chemotherapy and antibiotic regimens. Their retrospective analysis demonstrated convincing safety and cost effectiveness (Sive et al , ).…”

Patients’ experiences of different care settings and a new life situation after allogeneic haematopoietic stem cell transplantation

“…Over the past two decades, there has been an increasing tendency for selected patients to be treated in outpatient settings or at home during chemotherapy or after HSCT. One major justification for this choice of treatment is the growing imperative to improve patient experience (Mcdiarmid et al., ; Russell et al., ; Sive et al., ; Solomon et al., ; Svahn et al., ). Still, what does it mean for the patient to be at home?…”

“…In HSCT treatment in particular and in cancer treatment in general there has been a major shift over the past decades from care in a hospital setting to treatment and care for selected patients in outpatient settings, including the patient's home. The rationale underlying this shift has been described as the desire to improve patient experiences and quality of life, to avoid unnecessary hospitalisation, to rationalise the use of hospital beds, and to improve cost‐efficiency (Sive et al., ). In 1992, Russell, Poon, Jones, Woodman, and Ruether () reported some successful results of allo‐HSCT treatment in an outpatient setting without protective isolation.…”

General health, symptom occurrence, and self-efficacy in adult survivors after allogeneic hematopoietic stem cell transplantation: a cross-sectional comparison between hospital care and home care

“…The major driving force underlying this shift is the desire to improve patients' experiences, avoid unnecessary hospitalization, rationalize inpatient ward beds, and improve cost-efficiency. 21 In a HSCT setting in 1992 Russell and colleagues 22 reported of successful treatment of patients in an outpatient care facility, which became an inspiration to implement home care. Since 1998, treatment at home in the early neutropenic phase after HSCT has been an option offered to patients treated at the Center for allogeneic stem cell transplantation (CAST) at Karolinska University hospital.…”