Transformation in penile cancer management with centralisation and multidisciplinary care
By St George’s Hospital
Penile squamous cell carcinoma is a rare male cancer with an annual incidence of 1 per 100,000. In many cases (75%) the condition is curable but in a minority (25%) the condition can rapidly progress and become incurable. Before 2002, patients were typically managed in local centres where a consultant urological surgeon might see and manage one case per year. The team defined new surgical techniques for penile preservation, evaluated new ways of staging disease, introduced standardised histopathological reporting, worked with charities to improve patient information, monitored and improved patient experience, established a basic science research programme and designed and participated in national clinical trials.
"This was an inspirational 10-year initiative that was way ahead of the field. It is a difficult area that’s not talked about, but this is clearly an outstanding service – perhaps even internationally - that has the potential to transform the patient group it serves."
Beatson acute oncology redesign initiative
By The Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde
A combination of strategic reports and guidance, in addition to experience and local audit, led the Beatson team to develop a redesign proposal for increasing day case chemotherapy capacity, establishing a 24-hour telephone helpline to better support patients and staff, and an assessment unit to review patients timely and effectively.
The aim was to improve unscheduled care for patients with cancer, and to meet the increasing demand for day case chemotherapy. The Acute Oncology Assessment Unit (AOAU) is an 8-bedded nurse-led day case area where all emergency admissions to the cancer centre, patients presenting to clinics unwell, and those who become unwell during radiotherapy or chemotherapy treatment, are seen. Patients phoning the helpline can also be seen in AOAU avoiding the need to attend the Emergency Department.
"Treatment of side effects and a whole host of other issues make this an excellent initiative that should just happen everywhere. There are benefits both to the organisation and its staff and we particularly liked the fact that the Beatson didn’t just redesign the service but said what they were going to do next."
Integrating cancer care in a district general hospital
By Basildon and Thurrock University Hospitals NHS Foundation Trust
Developed from the existing specialist palliative care team, to encompass the acute oncology service and subsequently the cancer of unknown primary service, the integrated cancer care team at Basildon Hospital strives to provide a personalised, effective and responsive service that puts patients at the heart of decision-making. The service provides seven-day face-to-face contact and assessment for patients, wherever they are in the hospital, supporting them to receive the right care in the right place and in a timely manner.
"This unique initiative could be used as a model for any district hospital that does not have an oncology department. The use of contact cards for access to the specialist care team by patients and their families is an excellent idea and the idea of pooling resources is obviously a cost-effective one."
AOS extension to OOH: access to specialist advice 7 days a week
By Doncaster & Bassetlaw Hospitals NHS Foundation Trust
Doncaster CCG funded the recruitment of 2 further Acute Oncology Specialist (AOS) nurses to pilot an 8am-8pm, 7 days a week, including bank holidays, service at Doncaster Royal Infirmary. Bassetlaw Hospital continues to have a 9am-5pm service and telephone advice is given by the AOS Nurse after 5pm and during the weekends. The hours 8am-8pm were chosen in line with the hours that other professionals work, for example the 8-8 walk-in centre. 306 patients were seen during the pilot period of October – March and of these 151 were seen in the new working hours.
"A lot of district general hospitals find it very challenging to get people to take to take acute oncology seriously. This showed strong community liaison, made good use of nurses to improve patient care and demonstrated good practice."
Optimising one stop acute oncology walk-in bay: direct quality patient care & accessibility
By Queen Alexandra Hospital, Portsmouth
In its first 12 months, the acute oncology team (AOT) at Queen Alexandra Hospital, Portsmouth embarked on ensuring its patients and hospital colleagues had access to specialist oncology advice, the one contact number of AOT and the one email address of AOT. It also established close relationships with its stakeholders, such as the radiology department, which now provides AOT with twice a day per week, protected slots for ultrasound-guided ascites drain; the respiratory team who provides protected slots for malignant pleural effusion with insertion of PleurX (permanent chest drain), and also established a policy of treating all oncology thrombo-embolitic events, by capturing all the incidental VTE in its oncology response CT scans.
"The concept of protected slots to minimise delay in treatment and improve referral times is a great idea. The team have performed a really good evaluation of the project and gathered strong metrics that will have a huge impact on the hospital and patient safety."