Living with and beyond cancer: The improvement story so far - NHS ...

10 | Living with and beyond cancer: The improvement story so far
Brighton and Sussex University Hospital NHS Trust
Improving quality for patients with lung cancer
Summary
A process mapping exercise highlighted
areas for improvement in the care of
patients with lung cancer and led to a
newly designed pathway. A weekly
multidisciplinary Combined Cancer
Clinic (CCC) within the Sussex Cancer
Centre at BSUH has now been
established where patients at any stage
in their treatment pathway postdiagnosis
have a holistic assessment
carried out. The clinic has been
designed to be more flexible to suit
patients’ needs, allowing them to
trigger an appointment or cancel if not
required and rebook for a later date.
During the consultation a Treatment
Record Summary (TRS) is produced
which is given to the patient either at
the clinic or sent to them and their GP
within 24hrs. The patient also has a
detailed assessment and care plan
(ACP) completed by the specialist
nurses. All documents are given to the
patient to be kept in their own patientheld
record. Early feedback from both
patients and staff has been very
positive. Results from local and national
measures are still awaited as the study
period is not yet complete. Further
development of the CCC will see the
inclusion of a dedicated oncologist and
a thoracic surgeon.
The problem
A few issues were noted with the
current lung cancer patient pathway:
• Multiple clinics where patients
were seen
• Multiple sites where clinics were held
• Suboptimal Macmillan nurse
availability
• Periods when care passed between
different services with the risk that
patients could be lost
• Inadequate time with the patient for
a detailed assessment of all their
needs
• Lack of access to other services
particularly psychological support.
What we did
We held a process mapping exercise
attended by all healthcare workers
involved in the lung cancer service. A
detailed map of the current service was
reviewed and areas of potential risk
were identified. An ideal pathway of
care was designed/agreed by the MDT.
As part of the improvement, a
combined cancer clinic with
multidisciplinary input was established
and held in the Sussex Cancer Centre.
This clinic was designed for follow up
of anyone known to have lung cancer
(i.e. at any point beyond the
consultation where the bad news was
broken). Patients could be seen by
respiratory physicians, palliative
medicine specialists and the Macmillan
cancer nurses, with input from
oncology. The duration of the
appointment was extended to
acknowledge the amount of additional
work created by carrying out the
Treatment Summary Record and ACP.
These documents were given to the
patient in clinic once complete where
possible and kept in a dedicated
patient-held record. This enabled access
by the patient/carer, GP, community
services to vital information regarding
ongoing treatment plans, side effects
and complications, as well as signs
which may need further assessment by
a health professional. Patients were also
given the option of cancelling/delaying
their appointment if not needed, or
self-triggering a consultation if
required.
Local measures were set to ensure that
these changes were monitored both in
terms of their effect on the demand on
the service and quality of care provided.
An Access® based electronic database
for the completion of the Treatment
Record Summary and the ACP was
developed as completion of paper
based records during consultations
proved to be very time consuming. This
replaced the previous standard letter to
the patients GP.
Local measures included:
• Change in distress thermometer
scores (using DT) recorded at each
attendance in outpatients
• A local questionnaire assessing
patients’ experience of the previous
system of care with plans to reassess
the effect of CCC on their
experience
• The number of lung cancer patients
admitted monthly as unscheduled
attendances via A&E compared with
the same time frame in previous
years
• The number of outpatient
appointments triggered/cancelled
and DNA
• Referrals made to services outside the
MDT (e.g. psychological support/
dietician/physiotherapy etc).
What difference has the
testing work made
Early indications are that the new service
model is working. The ability to tailor
appointments to suit the patients’ needs
has been noted both by patients and
staff as beneficial and has led to a sense
of better quality care. Overall, although
the number of questionnaires given out
has been a little onerous only one
patient has declined to complete one.