Collaborative Practice. What Did It Ever Do For You? IMPACT ON COLORECTAL CANCER SERVICES Sue Rimes and Nicky Forsyth Taunton and Somerset NHS Trust 2004
A Few Ambitious Quotes! No one should wait longer than one month from an urgent referral for suspected cancer to the beginning of treatment except for a good clinical reason or through patient choice (NHS Cancer Plan 2002) To improve the experience and outcome of care by improving the way in which care is delivered (C.S.C. website) To optimise service delivery from the patient perspective and to support clinically effective care (CSC website)
History Of The CSC Started in 1999 to support the implementation of the NHS Cancer Plan (eg 2 week target). Avon, Somerset and Wiltshire Cancer services involved in 1999 as a pilot site.
Cancer Services Collaborative - The Objectives 1. Certainty and choice across the process of care 2. Predict patient requirements pre planning and pre booking 3. Reduce unnecessary delays and restrictions on access 4. Improve patient and carer satisfaction 5. Provide the best care, in the best place, by the best team
History of MPH Cancer services project manager appointed in 1999. Specialist nurses employed. Specialist post for GI radiographer established in 2001. Specialist nurse endoscopists trained from 2003.
Role of the Lead GI Radiographer Ensure lists run efficiently Run own lists and supervise others Train radiographers and SPR s Ensure waiting time targets are met Prioritise requests and liaise with referrers Monitor waiting lists and adjust sessions Work as part of the colorectal team
Tools available to us. Regular audit Process mapping every aspect of patient journey from primary care visit to discharge. Capacity and demand studies Colorectal team meetings Documentation of all Clinical Incidents Cancer Forum for Nurses (and AHP s)
Audits Undertaken On Quality of radiographer performed barium enemas Low residue diet for patients Radiographer vetting of BAE requests Clinical incidents (Inappropriate referrals) Outcomes radiographer led service, patient assessment sheets
Process Mapping For The patient journey colorectal cancer rapid referrals The patient journey the acute bowel The journey of the pink card through the x ray department (vetting of requests)
Capacity And Demand Studies.. Ensured success of the rapid referral service Identified a need for radiographer led BAE lists Identified a need for radiographer vetting of requests Ensured success of booked admissions programme
Forum for Colorectal Team Meetings Discussing problems Identifying needs Introducing new ideas / new ways of working Setting long term goals Giving the radiographer a voice within cancer services
Reporting Clinical Incidents Clinical incidents for Inappropriate requests identified Immobile Unable to give informed consent Unable to tolerate preparation Unable to follow commands etc Discussed with referring clinicians, tried referrer assessment without success
Solution Booked Admissions Programme New systems of work established, able to discuss concerns (informed patient consent), reduced DNA rate, better service for diabetics, patient self assessment sheets (drastically reducing clinical incidents)
What Did The CSC Ever Do For Me? Team of radiographers performing barium enemas Radiographer led lists Radiographer led training Radiographer vetting Better diet for patients Improved patient information Booked admissions- better consent/ better choice Patient pre-assessment sheets
What Next? To re visit the criteria for rapid referral Inclusion of other referrers in patient assessment Review of booked admissions Update of radiographer vetting protocols and training of staff Review of documentation
Radiology Contact Details Sue Rimes 01823 343038 susan.rimes@tst.nhs.uk Gill Garratt 01823 343038 gillian.garratt@tst.nhs.uk Louise Wynd 01823 343503 louise.wynd@tst.nhs.uk