Nurse Reduced Waiting times

Category:          Scheme best improving Patient Access to Services

Name:                Susan Mills

Job Title:            Gynaeoncology Clinical Nurse Specialist

Organisation:     Nottingham City Hospital NHS Trust

Email:                 smills1@ncht.trent.nhs.uk

Telephone:         0115 9691169 ext 46162

Key team:           Karin Williamson - Lead Clinician, Cathy Bown – Sonographer, Sue Mills - Specialist Nurse

Title:                  Nurse reduced waiting times for diagnosis of endometrial cancer

• Audit pre nurse led clinic highlighted delay in diagnosis of endometrial cancer up to 311 days.
• NHS Guidelines state patients referred on 2/52 wait should have a diagnosis in 31 days by 2005
• Patients had 4 separate visits to hospital before diagnosis.
• 1 visit to outpatients.
• 2-3 week wait for ultrasound scan
• Further visit to clinic for results of scan
• Further appointment for out patient hysteroscopy and biopsy
• Further visit for results of biopsy.

• Reduce patient and relatives anxiety
• Reduce number of visits and waiting times to diagnosis
• 1 year course at Bradford University in Hysteroscopy training for nurses
• Hands on training in own area. 50 observed, 50-100 supervised 50-100 unsupervised hysteroscopies.
• Written assessment plus viva.
• 1 of first 8 nurses in UK to become accredited nurse hysteroscopist.
• Started nurse led PMB clinic Jan 2003.

• Support from lead clinician Miss K Williamson Gynaeoncologist
• Cathy Bown Sonographer
• Developed protocols and risk assessment
• All patients have scan and medical history and examination on first visit by CNS
• Audit Dec 2003
• Total number of referrals 378
• 15 DNA total seen 368
• 189 referred for hysteroscopy (2nd visit)
• 126 discharged
• 23 cancers diagnosed.
• Times to diagnosis 17-83 days
• 13 patients diagnosed under 31 days 51%
• Pre nurse led clinic 23% diagnosed under 31 days.
• High patient satisfaction levels. 
• Continuity of care.

• No cover for clinic for A/L or study leave
• Ad- hoc clinics to meet demand for referrals
• Need additional hysteroscopy lists

• So many patients are pleased with the reduction in numbers of visits and reduced time to diagnosis.
• Prefer female practitioner.
• Patients diagnosed with cancer already known to me therefore better support mechanism already in place
• Need to look at increasing service to meet the demand and continue to improve times to diagnosis.

Derby City General Hospital have approached me setting up a similar service