The 2ww Colorectal Cancer Diagnostic Pathway Telephone Assessment - - PowerPoint PPT Presentation

The 2ww Colorectal Cancer Diagnostic Pathway

Telephone Assessment Clinic and Virtual Review Clinic Pilot

Mr Dimitrios Pissas MD, PhD – Consultant Laparoscopic General and Colorectal Surgeon Richard Bond – Surgical Care Practitioner (General Surgery)

Existing target:

Delivery of treatment for those diagnosed with cancer must not exceed 62 days (from the date of the 2WW referral).

New target (from April 2020):

Patients receive a diagnosis or ruling out of cancer within 28 days.

Current Performance in Scarborough Hospital

 619 2ww referrals over a 5 month period (average of 31 referrals per week).  87% of 2ww referrals were reviewed in Outpatient Clinic within 14 days.  Day 0 - 7

14%

 Day 8-14

73%

 Day 15-28

12%

 Day 29+d

1%

Current Performance in Scarborough Hospital

 619 2ww referrals over a 5 month period (average of 31 referrals per week).  87% of 2ww referrals were reviewed in Outpatient Clinic within 14 days.  Day 0 - 7

14%

 Day 8-14

73%

 Day 15-28

12%

 Day 29+d

1%

The Faster Diagnosis Standard (FDS)

Benefits for patients:

 Reduced patient anxiety and uncertainty of a possible cancer

diagnosis.

 Improved patient experience.  Potential for improved survival.

Benefits for clinicians & healthcare systems:

 Improved ability to meet increasing demand.  Reduce demand in outpatient clinics.  Reduced medically unjustifiable delays in care.  Improved quality, safety, and effectiveness of care.

Aims of Pilot

 Reduce time from referral to first assessment.  Achieve senior clinician review and reply to GP

with an outcome within 28 days.

 Reduce outpatient clinic burden and unnecessary

patient visits to hospital.

Pilot Scheme Timeline

(For patients who meet criteria and are recruited to pilot)

• 2 week wait GP referral (Day 0)
• Telephone Assessment Clinic (Day 1-3)
• Investigations under fast track pathway (Day 2-14)
• Virtual Review Clinic of investigation results

(GP informed of outcome by day 28)

New Referral Proforma

Referral Proforma – Patient Demographics

Essential to ensure correct identification of patient. Please ensure Contact Telephone numbers are up-to-date.

Referral Proforma – Patient Suitability Confirmation

***Referring GP required to assess patient suitability for telephone assessment at time of referral and confirm on proforma.***

• Is the patient able to independently answer questions regarding their PMH

and presenting symptoms/complaint?

• Does the patient have a disability which may be a barrier to telephone

assessment?

Referral Proforma – Reason for referral

In accordance with NICE Guidelines for recognition and referral of suspected lower GI cancer.

Referral Proforma – Clinical Examination

***Comprehensive abdominal and digital rectal examination by GP essential as patient may not be assessed in person by a senior clinician following referral***

Please use tick boxes provided if examination findings normal. Please record any abnormal findings, in as much detail as possible, using the tick box diagrams and spaces provided.

Referral Proforma – Referral Checklist

GP or Surgery admin clerk must ensure this section is fully completed and corresponding information is included in the referral. ***Missing information will result in patient not being recruited to pilot and potential delays to investigations, diagnosis and treatment.***

Telephone Assessment Clinic

Step-by-Step

 Patient initially contacted by Patient Access to confirm

availability for telephone assessment and booking of time slot.

 Patient contacted by Telephone Assessment Team for

telephone interview.

 Specific, standardised questionnaire used to assess patients.  Investigations booked on basis of information from GP

Referral and Telephone Assessment.

 Patient counselled during Telephone Assessment on nature of

investigations and relevant pre-procedure preparation.

Telephone Assessment Clinic – Safety Net

If patient:

 deemed inappropriate for telephone assessment  prefers to be seen in person by a clinician  uncontactable for telephone assessment

Patient booked for Fast Track Outpatient Clinic appointment and seen in person at the earliest available opportunity (safety net).

Virtual Review Clinic (VRC)

 Senior clinician will review investigation results by day 28 and

inform GP of outcome in writing, patient will receive a copy of the letter.

 Outcomes of Virtual Review Clinic: A.

Discharge

B.

Downgrade

C.

LGI MDT

D.

Refer to other specialities / MDTs

E.

Further tests under 2ww

F.

Urgent Fast track outpatient appointment

 Aim to start pilot Monday 9th September 2019.  Extremely important for GPs/Surgery Clerk to

fully complete new referral proforma.

 Without a fully completed Referral Proforma

patients cannot be recruited to the pilot.

If any questions, please contact:

 Liz Hill – Care Group Manager (Surgery)

liz.hill@york.nhs.uk

 Dimitrios Pissas – Consultant in General and Laparoscopic Colorectal Surgery

dimitrios.pissas@york.nhs.uk

 Adam Spray – Senior Operational Manager (Surgery)

adam.spray@york.nhs.uk