Changing practice based on emergency department evidence: Impact of a telephone helpline on emergency department (ED) and hospital avoidance, mortality and morbidity rates and patient satisfaction

Prof. Margaret Fry1, Meredith Oatley2

1University Of Technology Sydney , Sydney, Australia, 2Northern Sydney Local Health District, Sydney, Australia

Introduction: The number of cases of cancer in Australia has doubled in size since 1991 and is the second most common cause of death. Chemotherapy a common treatment of cancer is known to cause distressing symptoms (Stacey et al., 2014).  Patients with distressing symptoms will often present to an emergency department (ED) (Oatley et al 2016).

The aim of the study was to investigate whether an oncology telephone helpline could reduce ED presentations and hospital admissions.

Method: This was a feasibility study that evaluated the effectiveness of a Nurse Practitioner led oncology model of care that included a telephone helpline service

Results: The utilisation rate was 337 telephone calls involving 157 patients. The most common reason for calling the helpline was for symptom management (n=173:51%), followed by education regarding treatment (n=61:18%). All of the calls that were given a triage code 3 were for symptom management (n=31). As a result of calling the helpline, 49% (n=165) of callers were given advice, information or education, 22% (n=74) were referred on to other healthcare providers and 11% (38) were admitted. Of the 38 patients that were admitted, 9 were admitted directly from the urgent NP led assessment clinic, bypassing the ED.

Conclusion: This study has made a significant difference to oncology patients, reduced ED presentations, optimised symptom management, and standardized processes for telephone assistance from oncology experts. The implementation of the oncology telephone helpline has demonstrated how services can better support cancer symptom management and reduce ED workload and presentation rates.


Professor Fry is the Nursing and Midwifery Director Research and Practice Development for Northern Sydney Local Health District which is a conjoint Professorial Chair position with the University of Technology Sydney. She is also an adjunct professor with the School of Nursing University of Sydney. Professor Fry has 25 years emergency experience as a Clinical Nurse Consultant and authorised Nurse Practitioner (NSW).  Professor Fry has extensive emergency nursing experience and a proven research track with 139 peer reviewed publications and over $2.9million in grant, research tenders and or scholarship funding. Professor Fry’s program of emergency care research has established her as a national and international leader with strong clinical credibility. She has been involved, as Chief Investigator, in numerous research projects in emergency care evaluation, advanced nursing practice, and pain management and has undertaken significant workforce health services and practice research. Her program of research has led to significant Australian state and national emergency nursing practice change. Her recent program of research involves pain management, emergency care service utilisation, effective models of care, advanced nursing practice, the use of care bundles to support patient outcomes, and emergency discharge processes. In the acute in-hospital environment, she is working on interventions to reduce the occurrence of hospital acquired complications and representations.