Fig 1.
Patient routes that may lead to an emergency admission to hospital in England.
National Audit Office (2013) Emergency admissions to hospital: managing the demand. London, UK: National Audit Office. https://www.nao.org.uk/report/emergency-admissions-hospitals-managing-demand/.
Fig 2.
Emergency presentation/admission pathways in cancer patients.
NHS Direct/111: NHS health advice and information service; Acute Assessment Unit: acute medical assessment/short stay unit (maximum 48h stay); Community Nurses: district nurses and specialist palliative care nurses; Cancer Outpatient Clinic: scheduled oncology or hematology outpatient appointments; Elderly Assessment Unit: acute frailty assessment/short stay unit (maximum 48h stay). This trust has two sites, with all oncology and hematology services and Intensive Care Unit at one site and A&E, Acute Assessment Unit and Elderly Assessment Unit at the other site; and there are medical and surgical wards at both sites.
Fig 3.
CLD illustrating complexity in the reduction and management of emergency attendances and admissions in cancer patients.
CLDs are composed of two components: variables and influences (links). An influence has direction shown by an arrow and an indicator as to whether the influenced element is changed in the same (+) or opposite (−) direction as the influencing element.
Fig 4.
Reinforcing feedback loops in reducing and managing emergency attendances and admissions.
Feedback loops occur when arrows connect a variable to itself through a series of other variables. Reinforcing loops, which indicate that variables have an overall amplifying effect, are labelled with an “R” and a loop symbol. Balancing loops, which indicate that variables have an overall dampening effect, are labelled with a “B” and a loop symbol. The loop symbol is either clockwise or counter-clockwise, depending on the direction in which the loop is read.