P097: The emergency department experience for patients and caregivers referred from an outpatient oncology clinic

Introduction: Outpatient oncology clinics have become the mainstay of cancer treatment, but their limited services and hours of operation often lead to emergency department (ED) referrals. With Canada's aging population and cancer survival rates improving, cancer-related ED visits are becoming a significant aspect of emergency medicine. A cancer-related visit to the ED is associated with unique challenges for patients, their caregivers and clinicians. This study focuses on understanding the ED experience of patients and their caregivers sent from an outpatient oncology clinic to a separate affiliated large academic hospital. Methods: A descriptive, phenomenological study of interviews was conducted using the method of Giorgi. The sample included 12 participants (n = 9 patients, 3 caregivers) referred to the ED at a large academic hospital (i.e., Toronto General Hospital, TGH) following a same-day outpatient oncology appointment at an affiliated cancer centre (i.e., Princess Margaret Hospital, PMH). Interviews continued until thematic saturation. All transcripts were analyzed by 2 reviewers with bracketing to ensure accuracy. Results: Four themes were identified from analysis: (1) communication; (2) expectations; (3) care and symptom management and (4) potential improvements. Overall patients and caregivers felt communication between PMH and TGH, and from providers could have been better. Many felt there was a break-down in communication as they did not expect to go through the usual ED triage process, which caused additional anxiety and frustration with the wait times. The majority felt their symptoms were managed in a timely manner and reported the staff to be friendly, caring and professional; however, often felt forgotten and anxious due to a lack of “checking-in”. Their experience could have been improved by receiving more information on the process, a more welcoming environment and separate waiting area or private room for those who are immunocompromised. Conclusion: Although referral from an outpatient oncology clinic to the ED of an affiliated hospital is a common process within Canada, this is the first study to explore the patient and caregiver experience. Understanding the patient and caregiver experience is valuable for identifying quality improvement initiatives. Our analysis revealed the patient and caregiver experience could be improved with better communication and expectation setting regarding the ED process before and throughout the visit.

CSTAR, Robotics, and Minimally Invasive Surgery: An Interview with Dr. Christopher Schlachta

Dr. Schlachta received his undergraduate and medical degrees from McGill University. With a keen interest in various types of surgery, he then completed a surgery internship at Toronto General Hospital before choosing to pursue residency in general surgery here at Western. Subsequently, he returned to Toronto for a fellowship in advanced minimally invasive surgery and subsequently worked as a staff surgeon at the Wellesley Hospital and St. Michael’s Hospital, where he was the head of the division. Finally, Dr. Schlachta was recruited back to London to serve as the medical director of Canadian Surgical Technologies & Advanced Robotics (CSTAR) in 2005. He presently holds this position, as well as cross-appointment as a Professor in the Departments of Surgery and Oncology. He has been involved in numerous Canadian and world firsts in robotic gastrointestinal surgery. We had the opportunity to speak with Dr. Schlachta to discuss his surgical practice, current research, and the technology at CSTAR.