In 2016, 1621 patients received palliative-radiotherapy; 39.7% of total RT-patients. Patients have varying waiting times between decision-to-treat and start of treatment. Most palliative patients are treated within the accepted targets, however most don’t achieve best practice targets, which might be safe.
RT is delayed due to limited resources, including time available from doctors/radiographers. The palliative radiographer and team at VCC aim was to develop a rapid-access service onto Palliative Radiotherapy, to reduce the wait from referral to treatment time (RTT) with little or no disruption to outpatients and deliver the expected quality of care.
Investment from VCC SI Grant Scheme:
• £10,000 allowed 2 temporary upgrades and more hours to a part time staff.
• The funded 2-sessions per week were used to increase the palliative sessions to 4.1 sessions per week (from 1.5) and allowed data collection.
Efficiencies in the palliative RT pathway:
• Analysis showed the type of delays responsible. The main reasons were waiting for a Dr to leave outpatients, planning delays and approval delays.
• Allowed radiographer to attend daily palliative MDT meetings.
• Analysis showed that the radiographer was able to improve patient experience by expediting urgent/emergency patients that warrant acute access within 24-48 hours.
• The radiographer was also able to prevent delays when the patients had not been planned on time.
• An unintended benefit of the work was that the radiographer could help on other days, staff levels allowing.
• Reducing impact on other patients/clinics by not requiring the medical doctor.
Measurable indicative cost savings:
• Swimlane mapping was undertaken (see attachment VTF Presentation slide 5). The past state represented the baseline. The Opportunity Cost was calculated at £158.60 per patient.
• The current state map shows of the new way of working with an OC saving of £20.59 per patient.
• A potential future state map adopting more roles performed by the medics could further reduce RTT. This scenario has been calculated to be save £71.65 per patient. Development of radiographer services across Wales to further improve patient experience and reduce disruption to outpatients could save an opportunity cost of £211,224 per year at least, based on the number of patients treated last year.
• Feedback was collected from medics/radiographers (see attachment ‘Feedback’ attached) as part of an audit. It was collected to define how the project was going and where it needed to. It was positive and helpful in engaging staff with the changes).
• The patient experience team called and involved 108 palliative patients. It showed that 69% of patients were waiting in pain for RT. It highlighted how important palliative RT is for symptom control, and improving this can significantly affect patients’ Quality of Life.
Of the 108 palliative patients called, 69% of patients were waiting in pain. 45% of these patients hadsymptoms for over 3 months. A patient centred approach ensures that the targets are met without missingthe point.The average lead time for emergency patients had a step change in the process; from 34.2 to 18.5 hours.
The attachment ‘Evaluation’, page 7 that shows the graphs demonstrating this.‘If my husband had this service, we would have had more quality time’ A comment from the member ofthe public after a presentation by the radiographer at the Bevan Commission Conference.
Since undergoing the palliative service improvement project I have inspired a second palliative radiographer to train and start working in VCC, developing the palliative services’ robustness. I have also networked with radiographers in Singleton hospital and inspired a second department/radiographer to apply to the service improvement team at the Bevan Commission to improve their palliative radiographer services. I have offered to mentor their project.
Through networking I will visit other RT departments in England who have started this service and visit them to learn from each other and develop the future of palliative radiographer services together.