The Colorectal Straight to Test pathway Phil Andrews RN, Lindsay - - PowerPoint PPT Presentation

Improving Earlier Detection The Colorectal Straight to Test pathway

Phil Andrews RN, Lindsay Steward RN, Mr Michael Machesney, Dr Angela Wong

Barts Health NHS Trust

Based on a similar model from Dorset in 2008 Our Aim in line with recommendations from the DOH we have introduced a timely and efficient way for patients and GPs to get access to endoscopic services quickly

Straight to Test

Whipps Cross University Hospital A Re-cap:

• Started 18 months ago

5 clinics per week

• 2 nurses

6 patients per list

• 2 clinicians

600+ patients to date

• No admin

Data Snapshot

614

triaged so far 17 Cancers 63% Saving on pathway 36 Pts with IBD Excellent patient feedback Patient Orientated Low DNA rate

£134,562 Saving

Referrals 5 10 15 20 25 30 35 40 45 50 2 ww 18ww Upgraded

Demographic 50 100 150 200 250 300 350 Male Female Mean age 54 years

Triage Outcomes STT Endoscopy Clinic DNAs for Triage Pt cancel Triaged Triaged for CT Triaged for US

Procedures Colonoscopy Gast & Colon Flexi Gast & Flexi Gast CT Colon Other DNAs

<1%

76% 9% 12% 3%

Patient Outcomes

Diagnosis

Cancers IBD Polyps Diverticular Haemorrhoids Pancreatic on F/u CT

3% 7% 19% 13% 17% 0.4%

Follow Up Gastro/Surgical OPA GP Surveillance

Pathway 18ww Pathway – 37 days from GP to test Upgraded – 42 referrals – Triage to procedure – 11 days All breaches are due to patient choice and rebooking

What happens now

Nurse telephone assessment (can upgrade to 2WW) GP referral usually via CAB (3 week window – pt choice) GI investigation ? Out-patient review 2-6 weeks

How does it work in practice?

• Given as a ‘choose and book’ appointment
• Nurse assessment and triage at set time – dedicated phone line
• List of questions, including symptoms and any anticipated problems with

bowel prep. Simple algorithm to follow (covered in SOP)

• Pt updated on EHR and referral given to endoscopy admin to date
• or appointment requested for OPA / scan

How does it work in practice?

• Lower GI investigation performed
• Assessed by a consultant/senior health care professional
• Notes back to STT and decision made re follow up / surveillance / discharge is actioned
• If report is unclear on outcome, STT staff will discuss follow up with clinician and refer
• Database/audit on-going

Survey monkey Feedback:

• Patients
• GPs
• Endoscopists

Survey Monkey Patient Satisfaction

• No. of questionnaires sent

8 questions 80 patients 47 replies - 59% (Jan – March 2015) 94 % thought triage very convenient 79 % preferred phone to clinic 76 % who thought it was very responsive service 89 % very satisfied

Comments and suggestions

‘I’m very appreciative of both the treatment and care I had been shown. More convenient and no travelling’. ‘Far more convenient by phone, extremely professional throughout’ ‘Saves journeys and time on both sides’ ‘Very relaxed’ Brilliant method, well pleased with system’ ‘I felt very comfortable with the phone assessment. Got all my questions answered, it was great! Thank you. ‘Professionally explained- everything understood’ ‘More convenient on the phone, cheaper for the NHS’ ‘Thought it was an excellent time saving service’ ‘First class’ ‘A very well-run clinic’

GP Feedback April 2015

20 Questionnaires sent out

4 questions - 8 responded so far (40%) 1. Have you used it? 2. Any problems? 1. Any changes to improve? 2. Anything else?

Comments

• More advertising of service
• Accept faxed forms without CAB
• Excellent
• Very good as it is
• Very good service
• Option for urgent appointments
• Information leaflets to give to patients when

booked on CAB

• Occasionally appointments not available, and

too far between triage appt time and when pt will be called

Endoscopists Feedback Oct 2014

17 questionnaires sent out via email 4 questions and 4 responses – 23%

• How clear is the pathway?
• How comprehensive is the triage

form?

• Any problems with the service?
• How could service be improved?

Results and comments

• Unclear about follow up arrangments. The service may

reduce the need for outpatient review, but will have no impact on endoscopy demand.

• How patients will be followed up, no direction, no

referral pathways defined

• I have no idea how the pathway works
• Unclear who is responsible for these patients
• No idea where to send patients to after their test
• Need named consultant for each patient
• Clear agreed SOP
• Better communication with those expected to see the

patients and with the patients

Learning points

• Admin help ie. Arranging clinics, typing letters, send out letters and prep etc
• Short weekly meeting with clinic lead
• Communication –GPs, patients, clinical staff, admin staff
• Clear communication with endoscopists
• The importance of the database and audit trail
• Having a designated, protected clinic room and phone line
• Supportive clinical staff
• Peer review

Results

• Estimated savings to commissioners
• 492 clinic slots x £273.5 = £134,562

But also revenue from TACs minus cost of nurse Onward path of patient follow-ups may be shorter

• Mean total wait for 18WW: 37 days (63% reduction)
• Mean total wait for 2WW: 11 days (61% reduction)

Conclusion

• Successful implementation of pathway
• Reduced waits, financial savings
• Excellent patient and GP feedback

Thank you It’s a great service!