Sandwell and Birmingham Hospitals NHS Trust is one of the largest teaching hospitals in the UK. The trust provides services for a population of 500,000 across two hospital sites, both offering a full range of acute services. The Trust estimated there to be around 650 acute oncology related emergency admissions a year (approximately 3,189 bed days).
The Trust employs its own haematology consultants but receives oncology services through a service level agreement with the local cancer centre. A review of the current service against the recommendations for acute oncology highlighted the need to provide an expert ‘in house’ service to meet the needs of local cancer patients, in particular, for those undergoing chemotherapy and/or radiotherapy treatment or with acute onset of complications due to a known cancer diagnosis.
As there was a limited opportunity to change the Oncology SLA without considerable investment, the Trust established a nurse-led AOS with access to Oncologists. The service comprises:
Clinical Nurse Specialist Band 7
Specialist Nurse Band 6
Administrator Band 2 (3.5 WTE)
Oncology support is provided by two consultant oncologists providing a total of four afternoon sessions a week at the City Hospital site in addition to telephone support. The oncologists also provide advice on strategy and operational management to the team.
In nine months, the service – launched in September 2011 – successfully delivered improvements in:
- Emergency presentations through triaging
- Neutropenic sepsis -hour door to needle
- Diagnosing and treating metastatic spinal cord compression patients
- Identifying and learning from mortality and morbidity incidents
- Improving the service through data analysis, audit and patient satisfaction.
The service has made a significant impact on patient safety, experience and outcomes. As the it matures the team will look to continually improve to meet the needs of patients, carers and colleagues.
- To review and assess patients with a known cancer diagnosis, who present as an emergency at A&E or who have been admitted as an emergency to an inpatient unit or as a clinic walk-in patient.
- To triage patients and determine if the reason for presentation is oncology related and, if so, to facilitate the patient’s care to ensure a speedy supported discharge. This can include referrals into relevant support services and OP clinics.
- To improve efficiency for the Trust through reduced bed occupancy
- To improve the experience for cancer patients and their families by streamlining care and providing advice and emotional support to enable the patient and carers to self manage in their normal place of care.
- To provide a 24hour helpline service to provide advice and support for patients, carers and GPs for patients receiving chemotherapy.
- To ensure that patients who have suspected neutropenia receive IV antibiotics within 1 hour of presentation.
- To help prevent patient mortality and morbidity as a result of delayed treatment of neutropenia.
- To raise, throughout SWBH, awareness of the signs and symptoms of neutropeania and associated poor outcomes if door to needle times are breached.
Metastatic Spinal Cord Compression
- To assess and triage patients who have a suspected or confirmed diagnosis of metastatic spinal cord compression (MSCC) ensuring that their episode of care is compliant with national and network guidelines.
- To raise awareness within SWBH of the signs and symptoms of MSCC and of the pathway and treatment plans developed for this cohort of patients.
- To ensure patients receive whole spine MRI’s within 24hrs and treatment plan within 48hours to improve patient outcomes and subsequent quality of life.
- To audit timeliness of referral to investigation, definitive treatment and outcome of treatment to improve service quality.
- To retrospectively identify and provide counselling and patient information to bony metastases patients
- Mortality and Morbidity
- To audit patients who have died within 30 days of chemotherapy.
- To analyse activity data to look for trends in toxicity and complications.
- To agree actions and implement changes to reduce these events.
- To share findings and best practice with other trusts across the Network
- To determine if chemotherapy or radiotherapy have contributed to patient morbidity and ensure these cases are referred to the coroner and any learning is implemented to reduce and prevent recurrence.
Cancer of the Unknown Primary
- To support the development of a pathway and MDT discussion for this group of patients.
- To improve the outcomes and quality of life for these patients and their carers.
- To take the results of our activity data and patient surveys to continually improve pathways and services for patients and carers.
- To proactively develop the service in meeting patient expectations and delivering a service based of patient experience, quality of outcomes and efficient use of resources.
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