Storyboard submission Follow the detailed instructions in this template for writing a description of your storyboard. Type your information in each section below and save this completed storyboard document as a Microsoft Word file. Please spell check your storyboard before submission as it will be published on the NHS Wales Awards website. Please note: The storyboard should be between 500 1000 words maximum (including references but excluding headings, images or graphs) Submit your storyboard using the online submission system at www.nhswalesawards.org.uk by Friday 25 January 2013. Storyboard submission 1. Storyboard Title The introduction of electronic referral for Systemic Anticancer treatments at Velindre Cancer Centre. 2. Brief Outline of Context (Where this improvement work was done; what sort of unit/department; what staff/client groups were involved) The project took place at Velindre Cancer Centre (VCC) a regional centre that delivers non surgical treatment to patients in South East Wales. Each month approximately 200 systemic anti-cancer treatment (SACT) referrals require scheduling for treatment at VCC and its outreach locations. The ability to provide timely chemotherapy to our patients is crucial therefore a project team including chemotherapy nurses, clinicians and IT software developers was established to investigate the requirements.
3. Brief Outline of Problem (Statement of problem; how they set out to tackle it; how it affected patient/client care) Scheduling of referrals was dependant upon the clinican making a telephone call to the chemotherapy booking clerks during the consultation with the patient. Guidelines regarding priority of need and acceptable timescales were not in use. The referral process was therefore based upon a first come first served model. Time consuming remedial action, duplication of work and scheduling patients out of order were an everyday occurrence. In addition there was a perception that chemotherapy waiting times were unacceptable. In some cases patients were waiting for up to 6 weeks for their treatment causing stress and anxiety for both patients and staff. The booking clerks were asked to collect data manually to enable waiting times for chemotherapy to be established. The Velindre clinicians issued waiting times guidance based upon treatment intent. 4. Assessment of Problem and Analysis of its Causes (Quantified problem; staff involvement; assessment of the cause of problem; solutions/changes needed to make improvements) Manual data collection demonstrated several serious concerns: 1. SACT waiting times were deemed unacceptable by referring clinicians. Only 47% of patients were treated within 21 days of referral. 40 35 30 25 20 15 10 5 0 SACT waiting times December 2011 (n-169) 94% 78% 66% 47% 25% 10% 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks < 6 weeks referrals cumulative % 80% 60% 40% 20% 0%
2. Lack of information regarding SACT regimen requirements was commonplace resulting in scheduling errors and re-work for the booking clerks. 3. Patients were not scheduled according to priority of need. 4. The data was manually collected by the booking clerks, this process was extremely time consuming for an already stretched team. Research and brainstorming demonstrated that an electronic referral system for SACT referrals was a potential solution. 5. Strategy for Change (How the proposed change was implemented; clear client or staff group described; explain how they disseminated the results of the analysis and plans for change to the groups involved with/affected by the planned change; include a timetable for change) Benchmarking indicated that the concept of electronic referral for SACT referrals was not widely used elsewhere and so the solution would need to be internally developed. Consequently a series of workshops were set up whereby a wide range of staff including clinical oncologists, chemotherapy nurses, IT software developers and senior managers designed, built and tested an electronic referral form. The change was piloted by one of the clinical site specific teams and the chemotherapy booking clerks. A training package was generated and users received a training session prior to activation of electronic access rights. This model of training was used for the subsequent roll out to all of the clinical teams. The roll-out was completed within a 2 month timescale. 6. Measurement of Improvement (Details of how the effects of the planned changes were measured) Results of the implementation show: 1.Significantly increased consistency of data entry and completion due to a standardized format allowing appropriate scheduling.
2.The electronic system has enabled automatic prioritisation of demand and enabled a pull system to be developed whereby the patient is scheduled in accordance with the automatically generated target date. 3.Data capture is now possible. 4.Waiting times for SACT treatment have improved. In December 2012 94% of patients were treated within 21 days. 70 60 50 40 30 20 10 0 28% SACT waiting times December 2012 (n - 196) 61% 94% 1 week 2 weeks 3 weeks 4 weeks referrals cumulative % 80% 60% 40% 20% 0% 7. Effects of Changes (Statement of the effects of the change; how far these changes resolve the problem that triggered the work; how this improved patient/client care; the problems encountered with the process of changes or with the changes) The effects so far include:
Referral and target dates allow prioritisation and ensure patients are treated in turn. Improved efficiency by eliminating delays in contacting the booking centre and the resultant lengthy telephone calls required to communicate the scheduling requirements. Reduced rework and rescheduling. All relevant staff members can see the progress of the scheduling process ensuring complete transparency to previously unclear information. 8. Lessons Learnt (Statement of lessons learnt from the work; what would be done differently next time) Extensive planning required to ensure clinical buy-in to the project and subsequently to identify users and training requirements. IT support has been crucial, not only to create the electronic referral form but also to support immediate changes identified during the development, testing and pilot stages An identified member of staff is essential to troubleshoot problems and ensure compliance with the electronic process throughout the pilot and full roll-out periods. 9. Message for Others (Statement of the main message they would like to convey to others, based on the experience described) The project required full investigation of the process which has enabled significant streamlining to ensure best use of available capacity to ensure patients are treated according to defined clinical need. A collaborative approach and senior management support ensured the success of this project.