NHSCANCER                                          NHS ImprovementDIAGNOSTICSHEARTLUNGSTROKETransforming Inpatient Care Pr...
ContentsIntroduction                                                          3Winning Principle 1Electronic alerts for em...
From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles   |   3Intr...
4     |   From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles  ...
CFrom testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles           ...
6     |   From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles  ...
From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles   |   7As t...
8     |   From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles  ...
From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles   |   9    ...
10   |   From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles Ba...
From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles   |   11Mod...
12   |   From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles Si...
From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles   |   13• P...
14   |   From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles   ...
From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles   |   15Ben...
16   |   From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles   ...
From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles   |   17Cli...
18   |   From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles Re...
From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles   |   19   ...
20   |   From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles   ...
From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles   |   21   ...
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies
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From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies

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From testing to spread:Sharing the knowledge and learning from organisations spreading the Winning Principles - case studies
The spread case studies illustrate many of these factors and provide an opportunity for sharing ‘working’ knowledge and learning experiences with the intention to promote further spread, adoption and action of good practice across the country and benefit more patients (Published July 2010).

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From testing to spread: Sharing the knowledge and learning from organisations spreading the winning principles - case studies

  1. 1. NHSCANCER NHS ImprovementDIAGNOSTICSHEARTLUNGSTROKETransforming Inpatient Care ProgrammeFrom testing to spread:Sharing the knowledge and learning fromorganisations spreading the WinningPrinciples - case studies
  2. 2. ContentsIntroduction 3Winning Principle 1Electronic alerts for emergency admissions: How the learningwas spread from Sherwood Forest Hospitals NHS FoundationTrust and United Lincolnshire Hospitals NHS Trust 4Emergency admissions, the exception rather than the norm 9Patient Electronic Alert to Key-worker System (PEAKS) 14Pan Birmingham Network wide spread of neutropenicsepsis pathway improvements 16Commissioning and cost benefits of acute oncology:Supporting spread across the Anglia Cancer Network 19Winning Principle 2Spreading the enhanced recovery principles in patientsundergoing colorectal, liver and upper GI surgery 21Shifting care and reducing length of stay: Ambulatorycare beds in the haematology inpatient ward 23Adopting the 23 hour model for mastectomy patients 24Enhanced Recovery Programme (ERP): Integratedcare pathway for elective colorectal surgery 27Spreading Enhanced Recovery from one testproject to a network wide programme 29Delivering care in appropriate settings 34Enhanced Recovery: Colorectal cancer 36Breast inpatient care: Valuing patient time 38Winning Principle 3Protocol for patients admitted with clinical diagnosis of malignantbowel obstruction secondary to gynaecological cancer 39Winning Principle 4The ‘FAB’ Programme: Fatigue, anxiety breathlessnessprogramme for patients with lung cancer and their carers 42Acknowledgements and references 46
  3. 3. From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles | 3IntroductionThere has been good progress in patients with cancer or its symptoms, and totransforming cancer inpatient care. More be seen by the right person, with appropriateorganisations and clinical teams are adopting expertise. The Winning Principles underpinthe Winning Principles and adapting the new these improvements.models of care, but there is still more to bedone and the pace of spread needs to be Spread and adoption is not easy and requiresaccelerated (Consolidation Report: From Testing using a multi-level of methods, levers and factorsto Spread (2009) - published July 2010). to create, inspire and make the connections with people and organisations within the currentThe new levers supporting spread such as Quality, nature of the changing health landscape. TheInnovation, Productivity and Prevention (QIPP), spread case studies within this publicationGP commissioning and a patient led NHS will illustrate many of these factors and provide ancontinue to support the drive for improvement opportunity for sharing ‘working’ knowledge andand encourage further adoption of good practice. learning experiences with the intention toThe recent revised Operating Framework promote further spread, adoption and action(2010/11) highlighted the importance to continue of good practice across the country and benefitto deliver improvements in access and quality for more patients. The Winning Principles 1. Unscheduled (emergency) patients should be assessed prior to the decision to admit. Emergency admission should be the exception not the norm. 2. All patients should be on a defined inpatient pathways based on their tumour type and reasons for admission. 3. Clinical decisions should be made on a daily basis to promote proactive case management. 4. Patient and carers need to know about their condition and symptoms to encourage self-management and to know who to contact when needed.
  4. 4. 4 | From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles Winning Principle 1 Unscheduled (emergency) patients should be assessed prior to the decision to admit. Emergency admission should be the exception not the norm. Sandwell and West Birmingham Hospitals NHS Trust Electronic alerts for emergency admissions: How the learning was spread from Sherwood Forest Hospitals NHS Foundation Trust and United Lincolnshire Hospitals NHS Trust Background For the period 2007-2008 the figures the benchmark data. It appeared that The colorectal team at Sandwell and highlighted that 64% of all bed days patients were not under the care of West Birmingham Hospitals NHS Trust (3975) followed an emergency colorectal MDT members or (SWBH) and the Pan Birmingham admittance. A simple trend indicates interacting with the colorectal CNS Cancer Network (PBCN) have been that by 2010 emergency bed days will following an emergency admission working to improve patient account for 70% of colorectal and this required further investigation. experience, outcomes and reduce inpatient spells. At Sandwell General length of stay (LOS) for emergency Hospital (SGH) and City Hospital (City) The wider MDT is used to identify admissions of colorectal cancer almost 55% of emergency admissions healthcare professionals who would patients. ended without a specific surgical be reasonably expected to be involved intervention (surgery, invasive in patients with colorectal cancer. For Baseline data collection demonstrated diagnostics, or an invasive procedure). an analysis of Finished Consultant that SWBH colorectal services mirrored Episodes (FCE) as well as colorectal the national landscape. The service It was important to place the baseline surgeons clinicians from the had the largest number of emergency data into an operational context, the specialities of upper GI surgery, bed days and longest average LOS three years of data was analysed and gastroenterology, medical and clinical when compared with all other tumour used to identify a cohort of 250 oncology were also included. An FCE sites at the trust. patients for a review of the healthcare is only recorded when a patient is records (notes review). The review was passed into the care of a consultant designed to record patient journey and will not identify any discussion from arrival at A&E through to between colleagues concerning discharge noting any interactions or patients but as the HES data has only diagnostics of significance. patients with colorectal cancer Interactions include those by Allied recorded in their diagnosis the Health Professionals (AHP) and expectation is that the majority of specialist services but exclude ward patients have an FCE with a member rounds and observations where no of the wider MDT. further actions or decisions were made. The review also investigated if At SGH, 224 of 380 patients admitted admitted patients were brought to the as colorectal emergencies did not attention of the Clinical Nurse interact with a member of the wider Specialist (CNS) or multidisciplinary MDT. If patients with a short stay of team (MDT) during each stay and if up to four days are excluded (84) that any provisional discharge dates were leaves 160 (70%) patients with a stay decided as part of the patients of five days and greater who have not recorded management plan. The seen a member of the wider MDT. notes review validated the findings ofWINNING PRINCIPLE 1 the Hospital Episodes Statistics (HES) At City, 60 of the182 patients data review. admitted as colorectal emergencies did not interact with a member of the The notes review covered 20% of wider MDT. Excluding short stay colorectal cancer emergency patients (30) leaves 30 (50%) patients admissions for a two year period and with a stay of five days and greater provided context and granularity to who have not seen a member of the
  5. 5. CFrom testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles | 5wider MDT. At City there were 29stays of 16 days and greater that did Emergency Admissions - Health Record Audit - Health Care Role Interactionsnot have any interaction from the 100wider MDT until at least day six. 90 80The wider MDT interactions were Percentage of patients seencomparable with the interactions 70abstracted from the notes review 60were, for instance, documented 50CNS attendance is 18%. 40 30The data also demonstrated that just 20over 50% of patients admitted as an 10emergency did not have a procedureor intervention that could be coded 0 CNS Physiotherapist Dietician Social Pain Outreach Palliative Case Discharge US/MRI/with OPCS4 and that half of patients Services Management Team Care Team Manager Liaison CT/XRadmitted presented with symptoms of Healthcare Role Patients seen Patients not seenabdominal pain, nausea and vomiting.A report was presented to thecolorectal team, cancer services andcancer operational team, summarising Emergency Admissions - Presenting symptomsthe findings with a data appendixcontaining in depth analysis of ICD10 9 10codes, FCEs, co-morbidity etc as a 8whole trust and by individual site (Cityand SGH). Following discussions with 13the clinical director, management, the 7clinical team and the CNS’s it wasagreed that the emergency pathway 6 5 11would benefit from service 1 12improvement and that PBCN would 4provide a service improvementfacilitator (SIF) to support this work. 3 2Delays to progress 1. Pain and vomiting (50%) 8. Other (15%)The service improvement work had 2. Acute abdomen obstruction (4%) 9. Temperature >36C (1%)been authorised but the colorectal 3. Anaemia (4%) 10. Temperature >38C (3%) 4. Bleeding (10%) 11. Pain and vomiting 13%)service at SWBH were in a transitional 5. Constipation and diestension (1%) 12. Vomiting (10%) 6. Deep vein thrombosis (3%) 13. Pain (27%)state with a reconfiguration exercise 7. Generally unwell (9%)to integrate the service on a singlesite, adoption of bowel screening andtaking on the care of gynae-oncologysingle and dual stoma patients. Inaddition, the long standing Clinical were suggested and attempted on The City CNSs had reviewed theDirector was stepping down and it several occasions but it became clear findings and the graphicalwas uncertain who would be his that the opening steps of any representations of the patients timereplacement and the SGH site was improvement ideas would have to be spent in hospital. They commented ondeveloping a fast track elective small and local until some of the the fact that sometimes they werepathway whilst City were transitional issues had resolved only aware of a patients admittance ifimplementing enhanced recovery. themselves. they saw them on the ward or aService improvement methodologies relative phoned.
  6. 6. 6 | From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles They also recognised that the data showed that once they were involved Electronic Emergency Alert Model in a patient’s care that patient journeys became more ordered and Mail/SMS alert CNS attends Patient Speedy sent to CNS patient to receives discharge for the patient was brought to the when patient resolve timely patient attention of the wider MDT and arrives in A&E colorectal treatment received the appropriate clinical care or ward issues and referrals to allied health professionals (AHPs). The CNSs felt that if they were made aware of a patient being admitted that they could visit the patient earlier Using data for the period April 2007 - The median and mean LOS for the 19 and bring there skills and expertise to May 2009 and City MDT lists each patients who could reasonably expect bear in addition to the reassurance month there was circa 650 known to be colorectal emergency the LOS that having a known face (keyworker) colorectal cancer patients who would are as follows: visiting the patient would bring. The potentially trigger an alert for A&E Service Improvement Facilitator (SIF) attendance or and inpatient Mean 3.2 and Median1 with CNS shared the learning gained from admittance. Additions were also attendance 68%. Sherwood Forest Hospitals NHS added following each MDT. Foundation Trust and United (Caveat this is a small data set and for Lincolnshire Hospitals NHS Trust of The alert system utilised the existing City only patients but the mean is how successful their emergency Lorenzo IPM interface and the Health suggestive in relation to the increased communication alert system had been Care Professional flag on the patient CNS attendance). and the CNSs agreed that if a local PDS screen. Other than internal solution could be found they were interface team time there were no As well as the overall reduction in prepared to test it. additional costs associated with the IT median LOS there was also a interface. significant increase in the percentage On contacting the SWBH electronic of patients who stayed in hospital for patient record development team the Impact 0 to 5 days to 79%. The increase in SIF found that a similar system was The baseline data from April 2007 to CNS attendance may explain this shift being used by the infection control March 2009 identified 243 emergency as there are examples of potential team and with a little re-designing for admissions with a median LOS of 13 admissions to the wards being shifted operational fit e-mails and text days and a mean LOS of 20 days to the Surgical Admission Unit (SAU) messages could be sent to a for washouts, enemas and outpatient smartphone when a known colorectal The team were hoping that they could appointments which resulted in the cancer patient was admitted. reduce median LOS from 13 days to patients leaving hospital in less than 11 and aim for CNS contact with 70% four hours. Attendance of a known On 14 September 2009, an electronic of patients. patient with a fractured femur emergency alert test cycle was highlighted two missed follow up CT commenced at City Hospital to Test cycle preliminary results scans for which outpatient appoints ascertain if early CNS attendance and The results reflect the patient have been made. intervention would have an impact on population of City Hospital who are patient LOS using the model. generally in a fitter state than those of It also appears that early CNS Sandwell. There has been a response provides the junior doctors reconfiguration of the colorectal with a colleague who has a clinical service with the majority of surgery knowledge of the patient and this moving to Sandwell. may stop diagnostics test and unnecessary treatment being Alerts in total 45 undertaken. Alerts perceived to be colorectal 19 Actual colorectal related alerts 16
  7. 7. From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles | 7As the colorectal team had moved Emergency alerts: Internal What is the impact of thethrough their transitional phase these spread at SWBH incremental spreadindicative test cycle results helped Upper GI The emergency alert flags for Upperwith the consolidation of the project In April 2010, when it became clear GI have been populated using theboard and a commitment to test that there were delays in the second MDT outcomes from April 2010 andelectronic emergency alerts colorectal test cycle it opened a even with a small alert populationconcurrently on both sites for six window of opportunity to offer during the period the 1 May 2010 tomonths with the final three months emergency alerts to the upper GI 10 June 2006 they have receivedbeing used to test the impact of CNS team. The CNS were already seven emergency alerts for patientsfacilitated discharge. experiencing difficulty with knowing admitted as an emergency. when their patients were admitted.The second stage of the test cycle was The preliminary results meant that the Off those seven alerts, three patientsdue to start in March 2010 when it upper GI CNS could test the are still inpatients. However, thewas intended that an additional CNS opportunities this system offered results have been very encouragingwould commence in post. them. The SIF added the flags to the and match those of the trial with City system from ongoing MDT outcomes colorectal patients and the Upper GIUnfortunately, the new CNS will not and on the 1 May 2010 a test cycle CNS confirmed the following.be in post until after June 2010 and began. The upper GI CNS have readythat has delayed the test cycle start access to emails throughout the daydate. so preferred not to use a smart phone. Extract of Emergency Alerts - Upper GI
  8. 8. 8 | From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles These are early results and the Incremental spread – What has The spread still continues expected LOS represents best clinical been learned? The chemotherapy unit manager from experience as baseline data is still It was challenging to engage and City Hospital has enquired how she being validated and analysed. keep momentum with the colorectal could set up her own alert system to services but once the service ensure patients on active As encouraging as the preliminary improvement project was authorised chemotherapy who are admitted as data is, it is as encouraging that the and a clear need to alert the CNS had elective inpatients for all disease CNS has found the alerts very useful. been identified the Winning Principles groups don’t have their care In the past they would have been case studies provided a documented compromised. unaware of these patient admissions solution that could be shared with the and they are conscious that many of team and adapt to work locally. Cancer services at SWBH will approve their patients are on palliative care the roll out of electronic emergency plans more suited to management at It is useful to have the Colorectal alerts to all tumour groups if the data their place of choice, mostly their Project Board structure as it has from haematology and oncology, home. They have used the alerts to delivered the implementation of upper GI and colorectal can proactively manage the patient electronic emergency alerts and as demonstrate a reduction in LOS, pathways to ensure that patients word gets around the Trust other readmissions and unnecessary tests spend the minimum time in an acute teams are willing to accept the and diagnostics. setting receiving the most appropriate concept knowing that it has been treatment and medicines using accepted clinically by their peers. outpatient services for urgent referrals where required. The teams that you work with need to be aware of the value of Haematology and oncology benchmarked data and aim for a local The haematology and oncology team measurable target that can be were looking for a solution to the assessed against the benchmarked challenges of identification of patients data. who were admitted with potential neutropenic sepsis and delivery of the It is important to let the various teams one hour ‘door to needle’ time. find an operational fit for their own Flagging the patients has been service and needs and if its successful relatively easy but the alert has had to the message will spread and the roll be tailored to prevent false positives. out will follow. For chemotherapy patients the alert is only sent if it is an A&E or Emergency Ownership is key to spreading the Admission Unit (EAU) admission. learning. The colorectal CNS are spreading the message across the The alert however was only part of network with other cancer nurses the solution and it requires the through presentations and by word emergency admissions team to receive of mouth. refresher training and to adopt the HEAT campaign. In addition junior doctors on rotation and induction also require specific training. It is expected that in late June 2010, the Neutropenic Sepsis Alerts will go live to support the delivery of antibiotics within one hour of presenting at the trust.
  9. 9. From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles | 9 Winning Principle 1 Unscheduled (emergency) patients should be assessed prior to the decision to admit. Emergency admission should be the exception not the norm.Cambridge University Hospitals NHS Foundation TrustEmergency admissions, the exceptionrather than the normBackground • National End of Life Care Strategy – Problems identifiedCambridge University Hospitals NHS Advanced care planning and High frequency of emergencyFoundation Trust (CUHFT) is a large avoidance of inappropriate inpatient admission of cancer patients toteaching hospital located in South admissions CUHFT and the corresponding impactCambridge. The hospital has a • Chemotherapy Services in England: on bed days meant initialcatchment population of 500,000 but Ensuring Quality and Safety (NCAG) investigations and testing was focusedas a specialist tertiary centre serves a – Acute Oncology Service around Winning Principle 1 –wider patient group. Currently, CUHFT • The Quality and Productivity assessment prior to admission. Ashas 1,188 beds accommodating Challenge – which asks: How CUHFT has 69 inpatient beds within65,000 inpatient admissions each quality of care can be improved its cancer division, it was felt that ityear. Expansion plans for the trust whilst also improving productivity. would be appropriate to look first atover the next 20 years will see the the emergency pathways (seecapacity for clinical services increase in Local drivers pathway diagram) into this divisionsize by 50%. The hospital has an • Towards the best, together – East of and see whether any serviceaverage length of stay of 5.4 days and England SHA ten year strategy improvements could be applied herecurrently runs at an average capacity • CUHFT Effective Patient Care to make emergency admission theof 97%, both these figures are higher programme – reducing length of exception for these patients ratherthan the recommended national stay than the norm.averages and the local standards the • CUHFT Trust Values – Kind, Safe andtrust are aiming for of; 3.4 days and Excellent85% capacity respectively. • CUHFT Releasing Capacity – striving to reduce emergency departmentIn the March 2009, the Anglia Cancer and inpatient capacity.Network (ACN) provided funding for aService Improvement Facilitator post CUHFT Cancer Patient Statistics (February 2008 – January 2009)at CUHFT. The post was established tosupport CUHFTs inclusion in the Trust-wide 22,000 patients with a diagnosis of cancer attended CUHFTTransforming Inpatients programme statistics 6,100 inpatient admissions (38,300 bed days)being led by NHS Improvement. 3,100 emergency inpatient admissions (28,000 bed days)Strategic contexts warranting CUHFT Cancer division 14,500 patients attended the cancer divisiondesire to be involved with the statistics 2,350 inpatient admissions (15,835 bed days)programme: 1,600 emergency inpatient admissions (12,160 bed days)National drivers• Cancer Reform Strategy - 20% reduction in cancer inpatient bed days for each SHA• Our Health, Our Care, Our Say – Patient choice and care closer to home
  10. 10. 10 | From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles Baseline data Data Analysis (February 2008 – January 2009) To understand the current assessment processes for emergency admission Referral source Accounting for % of admissions patients admitted to the cancer division, The CUHFT Transforming 1. Self referral / Direct to ward 30% Inpatient Cancer Care project team 2. Emergency Department 25% conducted: 3. GP referral 15% • High level data analysis using PAS data 4. Outpatient Clinic 10% • Retrospective clinical notes audit 5. Oncology / Haematology Day Unit 10% • Patient satisfaction/experience 6. Inter-hospital transfer 10% questionnaire • Staff interviews and service evaluation questionnaire. Patient satisfaction and experience • Slow response times of Cancer The outcome of emergency questionnaire specialists to the ED attendance, i.e. admission or 274 questionnaires were sent out to • Lack of resources to carry out discharge following assessment, varies patients who experienced an thorough assessments depending on what route in to the emergency attendance / admission to • Too many emergency routes in to hospital the patient has taken. Those the cancer division between the hospital for patients admitted to patients who go directly to the ward November 2008 – February 2009; we the cancer division or to the Emergency Department (ED) received 103 responses, 31 of these • Professionals making decision to for an assessment have a 95% chance patients went through the ED and 73 admit tend to be recently qualified of admission after assessment, via the other emergency routes, and doctors with limited experience of compared to those who were showed the following: assessment and risk aversive assessed in either of the day units attitude to avoiding admission who have a 45% chance of admission • Patients want more information • Admitting patients appears to be following assessment. Except for a around symptom management at easier than considering alternatives small number of very poorly patients home, what to expect and who to to admission. who attended the ED, there was no contact in an emergency obvious difference in the acuity of the • 70 patients had a specific contact Objectives patients who came through the number to ring in an emergency; From the information we discovered different emergency routes. within this, there were 21 different through our comprehensive baseline people/places analysis, we set the following Retrospective clinical notes audit • High level of reliance remains with objectives: A clinical notes audit was undertaken the GP as first point of contact in an • Reduce unnecessary emergency on 51/147 emergency admissions to emergency admissions the Cancer division in January 2009, • Patients who attended a specialist • Reduce number of pathways and showed the following: area for assessment were more currently used by patients admitted satisfied with their experience than in to the cancer division • Documentation is poor and difficult those admitted via other routes. • Improve patient experience to track route from initial referral to • Have a reliable single point of assessment to admission Staff service evaluation contact to be used for advice by • 25% of emergency admissions interviews and survey patients and professionals could have been planned for or Staff interviews were carried out with • Improve recording of information predicted a wide range of multi-disciplinary • Embed a culture that views • 33% of the patients could have professionals who may be involved in emergency admission as a last been cared for elsewhere (i.e. in the the emergency admission pathway for resort. community, hospice or district patients admitted in to the cancer general hospital) division. To compliment the • 30% of patients admitted were in interviews, two short surveys were their last month of life. sent out to staff working the in the ED and cancer division, and showed the following:
  11. 11. From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles | 11Models for testing Cancer Assessment Unit Outcomes from testingThe results from the base lining The CAU was located in a four The CAU had 36 attendances, 28 ofprocess were presented to a bedded bay and staffed by an these were oncology patients andmultidisciplinary steering group, which Oncology Specialist Registrar, two eight were haematology patients.included both CUHFT staff and Oncology Clinical Nurse Specialistsexternal professionals. Internal staff and one Haematology Clinical Nurse This test increased the capacity forincluded; consultants, specialist Specialist. The pilot ran for two weeks assessment in a specialist area andregistrars and senior nurses from the and the assessment unit was open maintained the low admission rateemergency department, oncology Monday to Friday 08:00-17:00. Staff which was identified in the day unitsteam, haematology team and in the assessment unit also manned in the base lining exercise.palliative care team and there was the SPC and there was one SPC forinternal administrative representation Oncology and one SPC for Additional benefitsfrom the associate director and Haematology. • Assessment procedure andoperational manager of the cancer development of treatment plansdivision. External staff invited on to All areas within CUHFT which were was rapidthe group included the NHS identified as taking calls from patients • Improvements reported in recordingimprovement lead, lead commissioner or professionals seeking specialist of clinical informationfrom the PCT, a local GP, and cancer advice were given the bleep • Useful having one pathway forrepresentatives from the cancer numbers for the SPC and were told to emergency admission both for thenetwork. divert all calls during the two weeks to patient but also for the staff in the professionals carrying these terms of tracking admissions andThe steering group considered the bleeps. Advice given to patients were decision making processesvarious themes identified from the recorded on the electronic telephone • Staff reported that working withinbase line work and decided to test record form which was then faxed to the unit was rewarding andthree service improvement initiatives: the patients GP. interesting.i) Cancer Assessment Unit (CAU)ii) Single Point of Contact (SPC)iii) Electronic telephone triage system. Percentage of patients admitted following testing in three clinical areas during testing periodNB: During the five weeks preparationbefore the pilot it was felt that ii) and 100iii) would be more appropriate if they Percentage of patients admitted 14were combined into one work stream. 22 80By time of launching the pilot theelectronic telephone triage system had 60not been developed; however a newelectronic method of recording 40telephone advice was introduced to 36support those staff managing the 20single point of contact. 0 ED Ward CAU Clinical Area
  12. 12. 12 | From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles Single Point of Contact SPC The SPC was contacted 156 times, Patient Experience Results 118 of these contacts were oncology Single point of access: Wait to Current experience compared with enquiries and 38 were haematology speak to appropriate person previous experience of telephone enquiries. access Additional benefits 13% 13% 13% • Information and advice given over the phone to patients was much better recorded 13% • Time available for follow-up phone 25% calls allowed for safer practice and 54% continuity of care 20% 49% • Only 11 out of the 156 calls were redirected to the patients consulting team • 100% of GPs who received a copy of the electronic telephone record 0 to 5 mins 6 to 10 mins Much better Better form said that the seeing the 11 to 15 mins Not recorded Similar Not recorded emergency advice given to the patient was useful • 73% of GPs said that having a reliable SPC would help them to manage cancer patients safely from the practice/community rather than Benefits of these services ‘I was treated very well- as always. But sending them to the acute trust. The CAU and SPC have wide reaching I had the same nurse look after me implications in terms of service from coming in from home to being Financial Implications delivery and quality of care and would admitted on to the ward. Really quick • 833 emergency inpatient admissions benefit not only the trust and patients and it was nice to have her follow me August 2008 – July 2009; Monday - but also the commissioners and through.’ Friday 8am to 10pm primary care partners: One pathway • 202 of these admissions came through a specialist area would reduce Lessons learned through the day units which provide the rate of unnecessary admissions, • Engagement of all stakeholders the same level of specialist take pressure off the ED and inpatient from the outset of the project and assessment as the CAU ward areas and offer patients ensuring that the group plays a key • The extra 631 patients were continuity of care during anxious role in directing the project. admitted as inpatients via the ED or times. By offering a specialist Arranging short informal meetings went directly to the ward. assessment prior to admission in a individually with steering group specialist environment we have shown members in between formal Assuming that the extra 631 patients that admission can become the steering group meetings also had been assessed in the CAU where exception and not the norm. ensures they remain up-to-date with the 41% admission rate could be developments and their opinions are applied: Patient’s thoughts on their being constantly reviewed and • 259 patients admitted experience discussed. • 372 admissions averted (59%). ‘The pre-admission advice and contact • Clinical champions who bought in • 2,760 bed days or £1,023,960 prior to my admission via the doctor to the idea and were able to potentially could be saved. was second to none. I was constantly encourage colleagues to view the informed of the steps being taken to pilot positively. The most effective ensure my safety; including knowing a champions were those clinicians CT scan was being booked for the engaged on the ground floor who following day, so I felt more informed were already directly involved in and involved with my own treatment.’ assessments; clinical nurse specialists and special registrars.
  13. 13. From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles | 13• Patients at the centre of all Challenges became very evident. Also, the developments and service redesign • The pilot was limited because we environment was not ideal; the four options engages clinicians and helps also used staff from our existing beds were in close proximity to each to channel the direction of the human resource. This meant that and separated by curtains which project. we were unable extend the opening raise questions regarding its• Alignment with national, local and hours later than 5pm and as such compliance with single sex organisational priorities is key to get missed out on applying this model accommodation, there was not a engagement from stakeholders. to patients who attended the specified area for clinical Reminding people of this alignment hospital for emergency assessment preparation and only a small desk as often as possible helps to embed in the evening. for the staff to work on. the necessity of change and • Resources required to successfully • Identifying a single model of encourage a sense of urgency implement this service were initially emergency assessment which meets within the project. underestimated. During the pilot, the diverse needs of oncology and the need for increased access to haematology patients. both computers and telephones Emergency admissions pathway – pre testing Medical secretary Inpatient ward (95% admission On call SpR/SHO Oncology rate) On call SpR/SHO Haematology Emergency dep’t (95% Admission Consultant admission GP rate) Discharge Day units Day unit Other hospitals On call (40% Inpatient ward SpR/SHO admission Oncology rate) Patient Main hospital switchboard On call SpR/SHO GP liaison team Haematology Clinical nurse specialist Emergency admissions pathway – post testing GP Other hospitals Cancer Admission Patient Assessment Unit (41% admission rate) Discharge CUH Emergency Department GP liaison
  14. 14. 14 | From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles Winning Principle 1 Unscheduled (emergency) patients should be assessed prior to the decision to admit. Emergency admission should be the exception not the norm. Doncaster and Bassetlaw Hospitals NHS Foundation Trust Patient Electronic Alert to Key-worker System (PEAKS) Background The PEAKS Alert for cancer patients Patient Electronic Alert to Key-worker System (PEAKS) How it works went live at Doncaster and Bassetlaw Patient attends Hospitals (DBH) in September 2009, A&E/Emergency Admission initially rolled out by the lung multi- IT SYSTEM disciplinary team (MDT) and Information trigger PEAKS database Patient subsequently across every tumour attendance input of patients linked to specialist into PAS/EMIS group. The alert is now live across all treatment Patient live on four of the hospital sites in nine PEAKS updated tumour groups and the Specialist Key worker calls via CNS or MDT Palliative Care team. ward to check reason for Email and SMS message sent admission to key worker The alert meets the requirements of QIPP, showing: Key worker visits receiving areas (A&E, MAU, Patient/carer feel supported by key • Quality of care for patients and ward) Staff to inform of patient treatment plan/ worker awareness of visit carers is improved pathway/preferences • Innovation of ‘pull’ style alert • Productivity increase of the OUTCOMES Improved patient experience reduction in length of stay Reduced length of stay Reduced inappropriate • Prevention of inappropriate admissions admissions and treatments. The idea of the cancer alert came from a review of similar alerts implemented at both Sherwood Forest registered key worker informing them If the patient is admitted, the key- Hospitals NHS Foundation Trust and of the patient attendance and current worker gets additional alerts as they United Lincolnshire Hospitals NHS location. are transferred onto a ward, and so Trust. Both schemes were based on are again able to make contact with the RAPA (Recurring Admission This then enables the key-worker to the ward staff to ensure that they are Patient Alert) project work detailed in make contact with the clinical staff fully aware of the patient’s current Transforming Inpatient Care currently treating the patient initially diagnosis, treatment plan and Programme for Cancer Patients – The to understand whether the preferred place of care. Winning Principles. attendance is cancer related and then to ensure that the team are fully Funding The alert also met requirements for aware of the patient’s current DBH decided to develop the IT DBH to meet local End of Life Strategy diagnosis, treatment plan and functionality of the alert system after (2008) requirements and Cancer preferred place of care. considering the purchase of a bespoke Reform Strategy (2007) initiatives. If appropriate, the key-worker can visit system from an external supplier, as the patient and carers to provide this was felt to provide best flexibility How the PEAKS alert works additional support. In this way some and value for money. Additional costs When a diagnosed cancer patient emergency admissions have been included one off payments for mobile attends hospital as an emergency, the avoided, although it is acknowledged phone hardware and clinical audit registration (on PAS or eMIS) triggers that particularly for patients on End of support and regular costs for mobile the PEAKS system, which sends an Life pathways attending A&E out of phone messaging and calls and MDT alert in the form of a simultaneous hours, hospital admission may be administrative support. SMS text message and email to the appropriate.
  15. 15. From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles | 15BenefitsAfter the initial implementation, anevaluation demonstrated:-• Improved patient and carer experience (through collection of ‘good news’ stories)• Reduction in LOS for these patients (via Information department data)• Anticipated release of capacity in other areas as a result of patients not undergoing unnecessary diagnostic tests, treatment and medication.Additionally, feedback from theClinical Nurse Specialists (CNS), whoare the key-workers receiving the alertat DBH, suggests that while the alertis an additional activity to manage, ithas brought an increase in jobsatisfaction through seeing animproved delivery of appropriate carefor their patients and an improvedpatient experience.ChallengesThe key workers who receive thealerts work standard hours, sopatients attending out of hours (OOH)saw a delay in response time.However, part of the project alsoinvolved the circulation of detailedOOH guidance for the treatment ofcancer patients attending with variouscomplaints. Additionally the auditingof the project is currently aiming toidentify the reasons for OOHadmissions and inform work by othercommunity teams on improvingservices for these patients outside ofnormal working hours. It is an ongoing task to ensure that In conclusion, the overall feedback fromThe auditing process itself was an the ‘right’ patients are on PEAKS. the cancer MDTs is that PEAKS is aadditional burden on the key workers Initially, this means deciding how long positive initiative and good news storiesduring the initial six months of the ago a patient cancer diagnosis would and initial evaluations support this.implementation, but brought essential still be relevant in impacting on theirinformation and evidence to the likelihood of emergency attendance. After excellent initial success, theevaluation of the project roll out In addition, in order to maintain the Doncaster locality are already lookingregarding number and timing of accuracy of the patients on PEAKS, at the benefits of roll-out of thealerts, nature of attendance and there is a regular administrative PEAKS alert to bring benefits to theresponse times. Subsequently some requirement to update PEAKS with wider health community, for example,teams have retained the audit newly diagnosed patients for each patients undergoing chemotherapy orpaperwork to use to support their tumour group, which is currently with other long term conditions,own systems for patient monitoring. being undertaken by MDT staff. known infections or those on an End of Life Pathway.
  16. 16. 16 | From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles Winning Principle 1 Unscheduled (emergency) patients should be assessed prior to the decision to admit. Emergency admission should be the exception not the norm. Pan Birmingham Cancer Network Pan Birmingham Network wide spread of neutropenic sepsis pathway improvements A review of the neutropenic sepsis • A raised temperature may be the The review found the following: pathway identified that within hours only sign of infection in a • Lack of awareness of the pathway the team were able to deliver neutropenic patient. Conversely a and the neutropenic sepsis guideline antibiotics within one hour. Out of patient may be septic and not have • Difficulty in accessing the electronic hours (OOH) the pathway was not a raised temperature guideline able to achieve the recommendation. • Neutropenic sepsis is a medical • Lack of formal condition and central A 50% improvement and a three-day emergency requiring line management training reduction in length of stay have been commencement of intravenous • Poor symptom and condition achieved in the ‘door to needle’ OOH antibiotics. awareness neutropenic sepsis pathway at • Poor communication between in Birmingham Heartlands Hospital. The National Chemotherapy Advisory patient ward and acute ward Learning from PDSA cycles has been Group (NCAG) report, August 2009, • Poor awareness of key resources shared and spread to other trusts to recommends that the delivery of such as the triage bleep holder and improve Network wide delivery of the antibiotics ‘door to needle time’ patient alert cards ‘one hour door to needle’ should occur within one hour of • Variation in place of patient recommendation. presenting with neutropenic sepsis. presentation • Absence or poor availability of Network spread In January 2009, the PBCN intravenous antibiotics appropriate The testing work initially commenced commenced a three month audit to for the treatment of neutropenic with the OOH pathway at Birmingham capture ‘door to needle’ performance sepsis. Heartlands Hospital. This work has of trusts. Audit results highlighted subsequently spread to Good Hope variation in pathways and trusts ability Despite the availability of a pathway Hospital, and Solihull Hospital, the to deliver antibiotics within one hour. and tools to support delivery, there three acute sites which make up Heart remained barriers to staff using these of England NHS Foundation Trusts Birmingham Heartlands Hospital audit tools effectively in order to provide (HEFT). Improvements achieved at results highlighted that out of hours treatment in a timely manner. A (HEFT) have been shared and spread patients would present at A&E or the number of improvements were tested throughout trusts within the Pan Acute Medical Unit (AMU). In addition and measured to determine benefit. Birmingham Cancer Network (PBCN). the pathway was not delivering timely treatment. A project team consisting One point of access Background of senior nurses, haematologists, Previously, patients presented at A&E The PBCN guidelines for the matrons and a service improvement or AMU. Multiple access points management of Febrile Neutropenia facilitator (SIF) was convened and they impacted on the length of delay state that: agreed a period of service review. The experienced by patients. In addition • Neutropenia a neutrophil count of focus of the review was to gain a patients with neutropenic sepsis may <1.0 x109/l baseline through audit and an or may not have a temperature and • Febrile neutropenia is any fever of understanding of the OOH pathway. they can appear well. Without an 38 °C or more maintained for over In reality this meant meeting with understanding of the symptoms these an hour or > 38.3°C on one urgent care medical and nursing patients are at risk of not being occasion leads, a group of clinicians who are prioritised as requiring urgent outside the common groups of intervention. clinicians that the Network usually works with.
  17. 17. From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles | 17Clinical service leads agreed and Development of electroniccommitted to AMU as the designated patient alerts Benefits of training staffpoint of access for patients. A period An electronic flag is now attached to • Improved knowledge andof training for AMU staff to support the patient electronic record and it skills of nursingdelivery was also instigated. There was highlights the need for urgent • Increased likelihood of staffalso agreement to educate and treatment. The electronic flag was recognising the symptomssignpost patients to AMU. A by produced through partnership of neutropenic sepsisproduct of the project has been working between nursing and IT staff. • Supporting ‘right person,improved communication between It uses existing capabilities of right time’ thinkingteams and a breakdown of silo electronic patient record system, and • Increasing the liklihood ofworking. so did not incur any additional the delivery of timely care financial outlay. It also includes the • Terms such as ‘neutropenicPatient alert card redesigned alert card and guideline information. sepsis suspected’ orThe original patient alert card antibiotics given as perprovided patients with a 24 hour Future developments are planned policy’ are documentedtelephone contact number to access which will enable the system to be more frequentlythe haematology/oncology triage more proactive. It will be able to • Training providesbleep holder. The role of the triage communicate with a bleep or pager to coordinated way of raisingbleep holder is to provide the patient inform a nominated staff member of condition awareness andwith advice and support. Before the patient’s presentation to hospital. management which is intesting if urgent treatment was This would enable the individual to line with trust policy.required, patients were advised to provide timely support or administerpresent with their card at the antibiotics. The benefit of utilising anemergency department. alert system has been shared with various trusts within the Network. this update is 51% of patientsA survey identified 71% (28/44) of receiving antibiotics with an hour andacute staff had not seen a Delivery of competency a 72% within 1½ hours.neutropenic sepsis alert card, based trainingpotentially due to patients not The staff survey identified 68% Improving condition awarenessshowing the card to staff. Additionally (30/44) of staff surveyed had not read and management based on trustthe card did not promote urgent the guideline. In addition, 75% policy and guidancemedical treatment. (33/44) of staff had not had any A survey of acute staff identified that formal training in the management of 32% (14/44), do not know where toThe alert card was redesigned and is neutropenia. find the guideline and morenow visually alerting as it is red as significantly 45% (20/44) did notopposed to the original white. It The Haematology CNS now provides know there was a guideline.highlights the life threatening nature competency based training to acuteof the condition and provides patients staff which is aligned with policy. She Before testing electronic access to theand staff with a checklist of also provides nursing staff with guideline was not intuitive, it took tensymptoms. Staff members have readily practical skills to identify the steps and several minutes to access it,available guidance on how to treat condition, manage central lines and as it was not located in the trustthe patient and also directions on how facilitate the delivery of timely care. intranet policy section. Improvementsto access the electronic guideline on have been made so that access to thethe trust intranet. The impact of training has been policy takes three steps, it takes less shared with other trusts with in the than a minute and it is also linked toThe alert card is now used for all network. an electronic alert. Finally it is locatedhaematology and some oncology in the policy section of the intranet.patients on all three HEFT sites. For example at University Hospitals Birmingham Foundation Trust (UHBFT) Ensuring that trusts have an accessibleThe improvements in the HEFT alert the project team updated oncology policy or guideline in place whichcard have been shared with other nursing staff on how to manage supports staff in the delivery oftrusts within the network that are patients with suspected neutropenic treatment is the main principle beingadopting or adapting the alert card to sepsis. UHBFT report the impact of spread throughout the network.suit the needs of their patients.
  18. 18. 18 | From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles Reducing delays through Patient Group Directives (PGD) The OOH process from presentation to hospital The longest pathway delay exists from the point of medic assessment to the STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 time the antibiotic is prescribed. Patient Patient Medic Nurse Patient Baseline data showed 36% (5/11) of triaged is assessed prescribes administers admitted patients experienced an average delay by a nurse by a medic antibiotics antibiotics to hospital of 134 minutes at this point. A PGD is being developed which will enable specific nursing staff to prescribe and administer a stat dose of antibiotics. Once ratified the PGD will eliminate Improving communication Conclusion duplication, reduce hand offs and lead between teams to support co Underlying the improvements and to a decrease in delay to treatment. production learning achieved is a clear A survey highlighted that 61% (27/44) understanding of the pathway in Development of the PGD has been of acute staff did not know that there conjunction with hard work and drive challenging, primarily due to the was a triage bleep holder on Ward 19. of staff members at all levels of the number of teams involved in its In addition 66% (29/44) acute staff organisation to improving the development. Additional support for had not been contacted by the triage provision of care for patients with the PGD was gained by sharing bleep holder. This indicated that the neutropenic sepsis. pathway data on the OOH pathway communication between teams was performance and the impact of the not supporting co production. PGD at Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust where Improvements and benefits it provided a 69% improvement in achieved door to antibiotics time. AMU staff receive a verbal hand over from the triage bleep holder prior to Development of an antibiotics box the patient presenting at their unit. to improve access to treatment The verbal handover enables AMU to Access to the right antibiotics has prepare for the patient’s arrival. been achieved through the development of an antibiotics drug The double sided triage form has been box. The box is secure and lockable. replaced by the single sided UKONS It contains appropriate antibiotics, form. Staff find this easier to complete medical supplies required for the and understand. The completed form treatment of neutropenic sepsis and a is faxed to AMU providing timely paper version of the guideline. information supported by the verbal hand over. Once used the box is swopped with a fully stocked replacement box situated Reducing barriers to effective on the haematology/ oncology ward. communication between teams has In conjunction with the PGD the box improved the flow of information and will reduce the barriers faced by patients in the pathway. Improved nursing staff to deliver the one hour communication has also promoted co door to needle target. production as teams now support each other in care delivery.
  19. 19. From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles | 19 Winning Principle 1 Unscheduled (emergency) patients should be assessed prior to the decision to admit. Emergency admission should be the exception not the norm.Anglia Cancer NetworkCommissioning and cost benefits of acute oncology:Supporting spread across the Anglia Cancer NetworkCommissioners and trusts now have NHS Improvement as being associated There is a good case for establishingaccess to comparative information with these projects. Gross savings of network wide cost reporting on aabout costs of treating cancer patients £5.5m per annum in inpatients costs regular basis, harnessing the PbR datain the network, enabling rates of have been identified as realisable as a which is already being collectedemergency and planned admissions, result of implementing CRS continuously by PCTs, and in somelengths of stay and Payments by recommendations for these four cases by the SHA or its contractors, inResults (PbR) costs to be identified and projects, most of which occurs in order to monitor benefits realisation.compared for different tumour sites, acute oncology. This approach is being adopted acrossproviders and PCTs. This will help in the network to support the spread ofbuilding business cases for Programme Budgeting gives a good the Winning Principles.implementing nationally indicator of total cancer care costs perrecommended improvements, as well PCT, but does not provideas identifying inefficiencies in opportunities to analyse cost at levelstreatment practice within the lower than PCT.network. PbR data readily available in all PCTs,Published Programme Budgeting (PB) covering all surgical admissions anddata suggests the cost of treating many non-surgical treatments, can becancer in the Network is c£250m pa, combined across the Network givingand Cancer Reform Strategy (CRS) important comparative data. Thisdata suggests that about 50% of this work requires financial and IT skills tois Inpatient cost. Variations in PB cost be shared across the network and arelative to incidence suggest gross shared commitment to informationsavings of £30m pa across the exchange.network are possible if the cost percase of the three lowest cost PCTs Interest in using the tool which haswere applied to the three highest cost been developed, and interest inPCTs. Specialist resources were increasing awareness of costs, is veryconsequently commissioned to study high throughout the network.detailed Payment by Results inpatientdata for cancer spells in the network, Existing contractual and financialat a cost of c£40k. arrangements for cancer treatment are not widely understood by cancerPCTs have already reported savings of commissioners, especially in the non-over £1m pa as a result of this PbR areas of chemotherapy andanalysis. These and future consequent radiotherapy, where availability ofproductivity savings will enable activity and cost information differprojects to be implemented in the potentially for each provider. There isareas of acute oncology, 23 hour no consistent standard for whether tobreast, enhanced recovery and day treat chemotherapy treatment ascase chemotherapy, providing all of inpatient activity or not, or on how tothe benefits identified by the CRS and report it.
  20. 20. 20 | From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles Anglia Cancer Network - Potential savings per project
  21. 21. From testing to spread: Sharing the knowledge and learning from organisations spreading the Winning Principles | 21 Winning Principle 2 All patients should be on defined inpatient pathways based on their tumour type and reasons for admission.Aintree University Hospitals NHS Foundation TrustSpreading the enhanced recovery principles in patientsundergoing colorectal, liver and upper GI surgeryThe t rust is part of the Enhanced The project aimed to reduce length of LOS data collected through the DHRecovery Partnership Programme. stay by the following: database for each patient is beingEnhanced Recovery pathways have used in Statistical Control Charts tobeen introduced for patients • Liver pathway – reduce LOS for feedback improvement data to theundergoing colorectal and liver 50% of patients to ≤ five days teams. The mean LOS has gone fromsurgery. A pathway will also be • Colorectal pathway – reduce LOS 12.64 days to eight days following theintroduced for patients undergoing for 80% of patients ≤ five days launch of ERP (Source: Data submittedupper GI surgery. The two aims of the • Upper GI pathway – reduce LOS for to the DH database for each patientwork are to improve the quality of 80% of patients ≤ nine days. admitted to ward 10 from 12/12/2009care for patients and to reduce length to 13/04/2010).of stay. The impact is being measured through monitoring length of stay, readmission rates and patient satisfaction surveys. Reduction in length of stay has supported the closure of five beds on the enhanced recovery ward 50 40 ERP Commenced 30 Length of Stay 20 10 0 -10 -20 Patients Length of Stay The Mean (average) Upper Control Limit Lower Control Limit WINNING PRINCIPLE 2

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