Background: Over the years, the emergency department (ED) at the Singapore General
Hospital (SGH) has been seeing increasing numbers of patients with oncologic emergencies,
such as neutropenic sepsis, metabolic syndromes associated with malignancy, and patients
at the end of life from malignancies. This ED has an annual census of 140,000 with
an oncology-related attendance of about 4000. The tendency has been to admit such
patients to the Medical Oncology Department for further management. Palliative care
is currently not widely provided for such patients in the ED. Increasingly, patients
are expressing a wish to be managed as outpatients. Decisions on admission/discharge
are frequently based on fear of unsafe discharge of such patients or reluctance to
admit with signing of a refusal of admission form, with its attendant negative connotations.
The aims of this long-term study are to first determine the current state of management
of oncology-related emergencies presenting to the ED (MORE-ED) of the SGH and subsequently
to focus prospectively on specific areas of intervention required either for identified
presentations, such as neutropenic sepsis, the breathless patient, palliative care
provision, or to address cancer-specific management issues.
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