page 21. - The Royal Wolverhampton Hospitals NHS Trust

Praise for our Head and
Neck Cancer Service
Dawn Dawson (standing) with Dr Croline Brammer entering audit data.
Cancer Services at New Cross have been
congratulated for the quality of their
data collection.
The praise comes from the DAHNO
(DAta for Head and Neck Oncology)
Audit Coordinator at the Information
Centre for Health and Social Care.
As a result, the project is to be included
as a case history in this year’s DAHNO
annual report to illustrate how the trust
has managed to improve data collection
and quality in just one year.
The DAHNO audit, commissioned
and supported by the Care Quality
Commission, is a national review of the
care received by patients with head and
neck cancer.
It identifies areas of good practice, as
well as gaps in provision of care, across
the nation with the aim of improving
patient care and outcomes.
The task
The treatment of head and neck cancer
is complex and requires integration of
the skills of many different health care
professionals for the best results.
The data published by DAHNO can
reassure Care Quality Commission that
treatment decisions at an individual unit
are made within the context
of a multidisciplinary team
according to the Improving
Outcomes Guidance.
Data collected can also
be used as an indicator of
clinical performance to guide
resource allocation.
“We felt that the Head and
Neck Team at New Cross was
a unit to be proud of and,
so that we could reflect this
fact on the national stage,
our contribution to the
national audit needed to be
as complete and accurate
as possible,” said Consultant
Oncologist Dr Caroline
Brammer.
How we did it
Caroline added: “To do this, we
cross-referenced clinician and
trust databases not only to identify
discrepancies, but also to understand why
discrepancies were occurring.
“We discovered that the data for patients
who started their cancer journey at
hospitals other than New Cross Hospital
was being lost in the Trust databases due to
classification errors.
“For the Black Country Head and Neck Multi
Disciplinary Team (MDT), this amounted to
two thirds of our activity.
“We also discovered the many bugs and
idiosyncrasies of the Trust database (the
Somerset Cancer Registry) on to which
we were entering our data, learning how
to operate it more efficiently as well
as informing the database creators of
its problems to help them with future
remodelling.”
For the 2008–2009 DAHNO audit most data
was retrospectively added to the Somerset
Cancer Registry once the patients eligible
for the audit had been identified.
This was time-consuming for all members
of the team so, for the 2009/2010 audit, we
aimed to collect data in advance to spread
the load and to further improve data quality.
The results
Live data entry at the MDT has been
introduced to facilitate accurate coding
of diagnosis and the team has been
restructured to help the coordinator identify
where the patient is on their treatment
journey.
The MDT meeting discussion lists are split
in to pre-diagnosis, post-diagnosis pretreatment,
post-treatment and recurrent
disease lists.
This also helps us to meet both the 31
and 62 day waiting time targets set by the
government and those clinical best practice
targets which have been shown to improve
survival in head and neck cancer (less than
42 days between surgery and postoperative
radiotherapy).
The new data collection and recording
system is also helping with many other
aspects of patients’ care.
For the future
To provide a better service to all patients
and to help us gain a more useful picture
of our performance, we plan to collect
information of functional outcomes, such as
quality of speech and ease of swallowing, as
well as the information on recurrence and
survival currently collected.
All patients will be seen in a
multidisciplinary clinic at defined times after
treatment which is dedicated to the formal
assessment of these functional outcomes
and also identification of any unmet patient
concerns and needs.
Caroline said: “Participation in the DAHNO
audit has been hard work for both clinical
and non clinical members of the team but
the act of data collection through the MDT
itself can improve patient care by ensuring
that management decisions are made by an
expert multidisciplinary team and ensure
that the outcomes of treatment are fully
measured and understood.
“By having the full perspective of
treatment outcomes we can target the
right treatments to the right patients more
effectively and efficiently to provide the
optimum result in terms of survival and
quality of life. Thank you to all members of
the team.”
Caroline can be contacted at the
Radiotherapy Offices:
Extension 8304.
The Head & Neck Cancer Services MDT team at New Cross who have been
congratulated for the quality of their data collection.
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