Unscheduled visits to the oncology outpatient department: A guide for improving the efficiency of the health care framework

Objective: To identify the reasons for unplanned visits to the oncology outpatient department with a view to optimising the level of health care delivery. Materials and methods: This prospective observational study of unscheduled patient visits to the oncology outpatient department occured during the period 15th November 2012 to 12th December 2012. The different types of malignancies, along with referral mechanism, disease status and presenting complaints, were documented. Results: There were unscheduled visits in 169 patients - for clinical assessment in 101 patients (59.8%) or to have a prescription refilled in 68 patients (40.2%). For patients who attended for clinical assessment, the extent of disease was metastatic in 35.6%, locally advanced in 31.7%, localised malignancy in 14.9% and clear of disease in 17.8%. Oncology-related problems were seen in 68 patients. The rate presenting with true oncological emergencies was 7.4%. Pain was the most frequently documented primary symptom experienced by 44 patients, accounting for 43.6% of this grouping. When referred by a physician, patients were likely to have true oncology-related problems in 31.9% of cases and when self-referred, in 14.7% of cases. Conclusion: This is the first published study assessing the nature of unscheduled visits by cancer patients in South Africa. Pain was the most common presenting complaint. Programmes targeted at pain control and integration of care with primary health care professionals will enhance the service delivered. © Springer-Verlag 2013.