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 63% 614 17 Saving on triaged pathway Cancers so far £134,562 Low DNA Saving rate 36 Pts with IBD Excellent Patient patient Orientated feedback

Referrals 50 45 40 35 30 25 2 ww 20 18ww 15 Upgraded 10 5 0

Demographic 350 300 250 200 150 100 50 0 Male Female Mean age 54 years

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

Procedures <1% 3% Colonoscopy 12% Gast & Colon Flexi 9% Gast & Flexi Gast 76% CT Colon Other DNAs

Patient Outcomes Diagnosis 0.4% 3% Cancers 7% 17% IBD Polyps Diverticular 19% Haemorrhoids 13% Pancreatic on F/u CT

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 GP referral usually via CAB (3 week window – pt choice) Nurse telephone assessment (can upgrade to 2WW) 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 Comments and suggestions ‘I’m very appreciative of both the treatment and care I had 8 questions 80 patients been shown. More convenient and no travelling’. ‘Far more convenient by phone, extremely professional 47 replies - 59% (Jan – March 2015) throughout ’ ‘Saves journeys and time on both sides’ 94 % thought triage very convenient ‘Very relaxed’ Brilliant method, well pleased with system’ 79 % preferred phone to clinic ‘I felt very comfortable with the phone assessment. Got all my questions answered, it was great! Thank you. 76 % who thought it was very responsive ‘Professionally explained - everything understood’ service ‘More convenient on the phone, cheaper for the NHS’ ‘Thought it was an excellent time saving service’ 89 % very satisfied ‘First class’ ‘A very well - run clinic’

GP Feedback April 2015 Comments 20 Questionnaires sent out  More advertising of service  Accept faxed forms without CAB 4 questions - 8 responded so far (40%)  Excellent 1. Have you used it?  Very good as it is 2. Any problems?  Very good service 1. Any changes to improve?  Option for urgent appointments 2. Anything else?  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 Results and comments 17 questionnaires sent out via email  Unclear about follow up arrangments. The service may reduce the need for outpatient review, but will have no 4 questions and 4 responses – 23% impact on endoscopy demand.  How patients will be followed up, no direction, no  How clear is the pathway? referral pathways defined  I have no idea how the pathway works  How comprehensive is the triage form?  Unclear who is responsible for these patients  No idea where to send patients to after their test  Any problems with the service?  Need named consultant for each patient  How could service be improved?  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!