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38 | Living with and beyond cancer: The improvement story so far
Mount Vernon Cancer Centre
Identifying the potential to reduce hospital follow ups
Summary
The Mount Vernon Hospital head and
neck team run a weekly combined ‘one
stop’ clinic where patients can meet
with a range of health professionals at
one appointment rather than returning
to hospital several times. At the clinic,
they can meet with their surgeon,
oncologist, cancer nurse specialist,
speech and language therapist (SALT)
and dietician.
The problem
With the increasing demand on
capacity we wanted to identify if there
was a particular group (and if so what
percentage) of patients who could be
discharged to their GP instead of
continuing with follow up
appointments at the cancer centre.
What was done
During December 2009 and January
2010, doctors at the weekly combined
head and neck clinic were given an
audit form to complete when they met
with their patients. This form asked for
data re: patients diagnosis, type of
treatment received, year treatment
completed and if the doctor felt the
patient was suitable to be discharged
to their GP with appropriate support,
information and fast access back into
the combined clinic if requested. The
form also asked if the patient had been
given a future follow up appointment
at the combined clinic, and if so, when
and why was this Was it for for
surveillance, investigation, morbidities,
reassurance, needs to see SALT or
dietician or other (e.g. protocol /
routine). The form also asked if the
patient relapsed, was there still a
‘salvage’ treatment option available.
What difference has the testing
work made or identified
The audit has shown that there is a
particular group of patients who, with
the correct information and appropriate
support could be discharged much
sooner than they would under the
current protocol. The patients identified
for discharge to GP all appear to have
cancers of the oropharynx (i.e. front of
the mouth) so it is not necessary to
review the larynx with a scope to detect
recurrence.
A total of 92 (usable) forms were
completed that could be analysed. Of
these, 25 (27%) said that the patient
was suitable to be discharged to their
GP. 14 of these 25 patients had
completed their cancer treatment
between 2007 – 2009. If they were to
be discharged now to their GPs, it
would be considerably sooner than the
current protocol of five years post
treatment hospital follow up
appointments for head and neck
cancer patients.
Learning so far
The whole audit process was more time
consuming than we first thought it
would be. All the doctors in clinic were
positive about and willing to participate
in the audit. However, it is an extremely
busy clinic and it was quite a challenge
to get as many forms as possible
completed.
Things that would have helped the
audit were:
• To have had a clinic list of patients
beforehand to complete the basic
data for each audit form and insert at
the appropriate place in case notes
for completion
• Include more tick boxes to avoid
issues with handwriting and the need
to relook at case notes to fill in gaps
that were not completed by the
doctors
• To include on the audit whether, if
follow up is required, this should be
by surgeon or oncologist or both.
Next steps
To date the findings from this audit
have been presented to the two
oncologists for the combined head &
neck clinic. They will be presented to a
wider audience when an opportunity
arises.
To implement the study findings one
suggestion is for all patients to have a
review after two years of follow up.
A decision could then be made to
discharge selected patients early after a
number of factors had been considered
including tumour site and difficulty of
surveillance, ongoing morbidity,
compliance with follow up
appointments during the preceding
two years and continued smoking or
drinking.
Contact
Teresa Young
teresa.young2@nhs.net