Lucy Gladman General Manager BHRUT Lung MDT Large Acute Trust 1 - PowerPoint PPT Presentation

Lung Cancer MDT Project BHRUT Lucy Gladman – General Manager

BHRUT Lung MDT Large Acute Trust  1 st April 2014 – 31 st March 2015*  Population ~ 750,000 – 303 primary patients diagnosed – 306 patients discussed at MDT – Treat 10% of London's cancers;  203 treatments – 50% of NEL’s cancers  37 monitoring  44 chemo Financially challenged   6 chemo radiotherapy  39 palliative care Special measures since January   50 surgery 2014  27 radiotherapy Staging completeness Jan – Dec  2014 – 89%** * Somerset, ** COSD

Project Objectives  To establish baseline metrics;  To redesign and implement an MDT model that meets the requirements of the London Cancer pathway specification;  To devise a plan for monitoring and evaluating the effectiveness of the redesigned MDT;  To measure and evaluate the impact and effectiveness of the revised MDT model and ensure alignment with national best practice;  To use the intelligence gained to develop a “blue print” model and recommendations for wider implementation.

Project Support  Two partnered Trusts to pool expertise;  Supported by Medical and Educational Grant from Pfizer;  Project manager appointed from Quintiles;  Lead Clinician for Cancer;  Lung MDT Clinical Lead;  Service Manager for Respiratory;  General Manager for Cancer.

Baseline Data Top priority KPIs:  Time from referral to DTT; – Number of patients who go on to treatment; – Number of patients who go on to be enrolled in clinical trials; – Additional KIPs  Number of new patients per MDT; – MDT attendance; – Time from referral to diagnosis; – Time from referral to staging; – Time from staging to DTT MDT; – Proportion of patients to: –  Surgery  Chemotherapy  Palliative intervention.

Project Timeline

Workshop  7 th January 2015;  23 attendees – Physicians, Surgeon, CNS’s, MDT Coordinators, Hisptopathologist, Oncologist, Palliative Care, Radiologist, Managers  17 high level actions identified;  Three overarching themes:  MDT  2WW  Surgery

Actions Identified  Excessive workload of the lung cancer MDT and need for lung nodule MDT;  CT scan required prior to first OPA;  Optimise days for EBUS;  Increased lung function capacity required  PET scanner needed;  Communication between Trusts  Improved data

Actions Implemented  Nodule MDT; – Protocol written; – Budget identified for admin support; – Advertised and interviewed 27 th May. – Start date TBA!  To pilot nurse-led nodule service; – Business case to be developed

Actions Implemented  CT scan prior to first OPA;  Previous implementation put 2ww target at risk;  Audit undertaken of 2 weeks of 2ww referrals; – Understand actual demand – Try to establish protocol for Cancer Referrals Office  Meeting held with radiology for them to understand MDT requirement;  Need to identify area for CT hydration patients

Actions Implemented  Excessive workload of MDT;  Audit undertaken of delayed patients due to unavailability of notes at MDT;  Nodule MDT will move some workload;  Inter-MDT process refined;  EBUS moved to Wednesday; – Reduces number of patients not discussed at MDT;  Review MDT Coordinator support; – Pool work across site; – Band 3 support to coordinate MDT agenda

Actions Implemented  Enabling works for PET scanner; – Awaiting financial approval;  Need business case to increase lung function test capacity;  Meeting with Bart’s Health – 4 th June 2015, to improve communications;  MDT received training on how to improve data quality for NLCA;  Review MDT once all actions implemented.

Summary  Identified short, medium and long term actions;  Brought team together;  Focused the actions needed;  Raised profile of cancer targets with the clinicians;  Identified audits to be undertaken;  Project overran; – Restructure; – CQC re-visit  Committed to keeping up the actions.

“If there is no struggle, there is no progress.” Frederick Douglass