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 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. ***Comprehensive abdominal and digital rectal examination by GP essential as patient may not be assessed in person by a senior clinician following referral***
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: Discharge A. Downgrade B. LGI MDT C. Refer to other specialities / MDTs D. Further tests under 2ww E. Urgent Fast track outpatient appointment F.
Aim to start pilot Monday 9 th 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
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