Julie Callaghan
Cancer Services Development Manager,
Sherwood Forest Hospitals NHS Trust
Tel: 01623 622515 ext: 3276
Email: julie.callaghan@sfh-tr.nhs.uk
Summary:
The key aims of the initiative were to provide the Trust with a tool to capture accurate, prospective data on all patients referred or suspected of having cancer and to help the Trust achieve the new Cancer Waiting Time Targets effective from 31st October 2005.Historically, the Trust has collected retrospective cancer data. With the new Cancer Waiting Time Targets we recognised the need to provide our clinical teams with ‘real-time’ data to help them manage their patients. The Trust developed an existing IT system that is now used to collect prospective cancer patient data across all tumour site groups.
Abstract:
The aims of the initiative were to implement an IT solution that would allow the Trust to be able to track and monitor cancer patients against the new National Cancer Waiting Time Targets. These new cancer targets came into effect from 31st October 2005. Historically the Trust captured cancer data retrospectively so we embarked on this initiative to transition our data collection methods and systems from retrospective to prospective data collection. The IT solution developed (Orion Tracker) is primarily used by a small team who are responsible for tracking patients. We also developed reports within the system for use by our Lead Clinicians and Service Divisional Teams to manage patients on a cancer or suspected cancer pathway.
The initiative has received Trust-wide support, with active involvement from the Chief Executive, Divisional Managers and Lead Clinicians. In addition, the Mid Trent Cancer Network and Cancer Collaborative Service Improvement Team have supported the Trust with this work. The primary change management tool used was the Cancer Collaborative - Plan, Do, Study Act. After planning we piloted prospectively tracking in one tumour site using an excel spreadsheet. The processes and data fields were refined during this stage. We were then able to develop and design our existing IT system, Orion and created a Cancer Waiting Times, Tracker module. Each Tumour Site Group was transitioned to the new system over a period of 4 weeks and went live on 1st September 2005. Escalation procedures and exception reporting have also now been developed and agreed with our Lead Clinicians, Divisional Managers and patient trackers to sustain the service improvement initiative.
It has been recognised nationally that patients referred with a suspicion of cancer want a speedy diagnosis and if cancer is diagnosed, they want their treatment provided a soon as possible. Being diagnosed with cancer can be a traumatic experience and one way to reduce this is by receiving timely care. Our Clinical Teams made a request for timely patient information to help support them with managing patients on a cancer pathway. By implementing a prospective data solution we are now able to provide this. With the Department of Health introducing cancer waiting time targets and prospective weekly reporting we realised the need to review and revise the way patients are managed at our Trust. This initiative addresses both local clinical needs and National requirements.
The Trust had an existing team of Cancer Data Administrators and it was decided to use this team and develop their roles into Multi-Disciplinary Team Co-ordinators or patient trackers. With the extended roles, these team members now have the opportunity to become more integrated within their respective tumour site groups and by supporting the team with managing patients on the pathway. The Multi-Disciplinary Team Coordinators prospectively track and record all suspected of confirmed cancer patients using the new IT solution, from referral to treatment. The team have received training to help them transition into these new roles.Before the implementation of the IT solution, the Trust had no means of ‘real-time’ reporting or proactively managing patients. A baseline assessment of Cancer Waiting Times has been done prior to the implementation of the IT solution. A further study is being done for October 2005 to review the impact. From the monthly Cancer Waiting Times data submitted by the Trust to a National Database, we can already see the benefits of tracking patients. Over the last 6 months the Trust has reduced patient waiting times significantly in all tumour site groups.
Waiting Times performance has improved significantly. All patients referred to the Trust with suspected cancer are now tracked or navigated through their pathway and receive much more timely diagnostic investigations and treatment. The number of patients not treated within the targets is now only a small number of cases that have been identified in the main, to be those patients having complex diagnostic or treatment pathways. From a previous patient survey we know that patients, once diagnosed want their treatments quickly. With MDT Co-ordinators and a patient tracking solution the Trust can strive to achieve this. A further patient survey is planned for January 2006 where we will be able to assess the benefits for patients.
The solution covers all tumour sites and supports the different pathways that patients suspected of cancer can take. Patients can have several investigations in order to exclude or confirm cancer and we are able to accommodate all of these, diverse pathways. The reports produced highlight where patient are in their pathway and this prompts the clinical teams to ‘navigate’ patients to the next stage. The reports are also used by management to help manage the provision of cancer services for the demand on the various Trust services they may require.
Our patient tracker solution has been demonstrated to other Trusts both within and outside of the Mid Trent Cancer Network. The Trust also has representation on several local and Network Cancer Groups, where the progress and success of this initiative has been shared Nationally, the majority of Trusts have similar solutions either fully or partially implemented, but there has been considerable interest in our Trusts’ solution because of the richness of information provided and the relatively simple manner in which the solution has been developed, piloted and implemented. This initiative was also supported by the Mid Trent Cancer Network, Service Improvement Team and has been recorded on the National Cancer Collaborative Web-Site (Web based Information Learning Tool).
The solution was developed and installed within a tight timescale. This initiative required input, commitment and co-operation from staff in many different departments within the Trust. The success of the implementation was primarily down to the excellent cross-department teamwork. The teams involved in the delivery of this IT system demonstrated enthusiasm and a determination to deliver a solution that would put the Trust in a strong position to be able to track, monitor and achieve the new National Cancer Waiting Time Targets and in turn improve cancer services for patients at Sherwood Forest Hospitals NHS Trust.
