Implementation of a colorectal 2-week wait telephone triage pathway. Melinda Kemp Lead CNS for 2WW Pathway Cassie Dovey Lead Colorectal CNS

Transcription

1 Implementation of a colorectal 2-week wait telephone triage pathway Melinda Kemp Lead CNS for 2WW Pathway Cassie Dovey Lead Colorectal CNS

2 Challenges Increasing demand population demographics GP targets New NICE Referral Guidelines Regular cancer awareness programmes 2013/ referrals; 2015/ referrals (^^) referrals per week Failure to meet targets Recognised and highlighted by internal validation 2016

3 Traditional 2WW Pathway Referred by GP All patients seen by consultant / team in outpatient appointment 6-8% diagnosed with a bowel cancer Current length of time from GP referral to initial clinic OPA with colorectal team 14 days

4 Number of Referrals Why change the pathway? 2WW Referral Numbers % Change from Financial Year 0

5 Advantages of the colorectal 2WW nurse led triage assessment Decrease waits for colorectal 2WW referrals Decrease time to treatment Appropriate triage and counselling of patient Safe assessment of patients suitability for investigation Free up consultant time to see more urgent and routine referrals Continuity for GP s Saves money

6 Pilot Aim of pilot to examine the potential for changing the pathway and evaluate the patient experience July September 2016 (8 weeks) 2 GP practices All colorectal 2WW referrals triaged patient by telephone to the appropriate investigation

7 Results of pilot 21 patients referred during the 8 week period 2 patients with rectal/abdominal mass sent to clinic. 1 patient triaged straight to clinic Triage team unable to contact 1 patient (as per pathway, sent a clinic OPA)

8 New Pathway We secured an NHS England Service Improvement Grant 6 month secondment for Lead CNS for Pathway and Admin support Officer Implementing a phased roll out Attending GP Forums and individual practices to inform of new pathway Implementation of information packs for GP practices and CNS team

9 How did we implement the new pathway?

10 Phased roll out 3 CCG s with a combined population of 585,000 South Worcestershire CCG 36 practices (302,000) Wyre Forest CCG 12 practices (112,000) Redditch & Bromsgrove - 22 practices (171,000) Each practice is contacted 2 weeks prior to going live with the new pathway and a Go Live pack is sent to them with all required information. Presentations to individual practices are arranged as and when required

11 Triage clinics Currently 7 telephone triage clinics are held per week 7 patients per clinic, at 30 minute intervals Currently all telephone clinics are working to full capacity Clinic sessions are a combination of mornings, afternoons and evenings

12 Colorectal 2ww Nurse led Triage Phase 1 Implementation (Feb to Aug 2017) 141 telephone triage clinics held as of 14/8/17 Total 626 patients triaged Mean time from referral to triage 24hrs Time to test/diagnosis Endoscopy 14/15 CT 23/39 15% 3% 7% 6% 4% 53% Colonoscopy Colonoscopy/OGD CT scan CTC CTC/OGD Very low pick up rate (5%) 12% OPA Removed from pathway

13 Mean Time (d) Referral to first assessment time Nurse

14 Patient feedback Overall how would you rate the Colorectal Two Week Wait Nurse-led triage service? 5% 94% said they would have telephone triage in the future 42% 53% Excellent Good Other 95% reported being satisfied with the quality of telephone triage

15 Feedback comments Brilliant service from start to finish. Carried out by caring professionals. A very pleasant experience with friendly staff who put you at ease You were on the phone within a few hours of my GP appointment, and in 13 days thereafter I had 2 phone calls, blood tests, a hospital briefing and the actual colonoscopy. Amazing! I wish all referrals and appointments were as nice and straightforward as this one - great results. Excellent idea. Saves time and energy. Nurses were professional, well informed and patient with questions.

16 Patient success story

17 Implementation challenges Finding a location to deliver clinics Obtaining equipment computer, desk etc Ad-hoc clinics Managing patients expectations Training of staff Staff confidence/support of staff

18 Next steps Await approval of the business case... Continue roll out across remaining CCG s Appoint and train additional staff Additional admin support Dedicated office space Service development -additional clinics etc

19 Questions?