Trust develops a programme to facilitate rapid access to diagnosis and enhance lung cancer management, reducing treatment delays and improving patient outcomes

Outline:

Lung Cancer is the biggest cause of premature death in Greater Manchester above any other disease or cancers combined. Based on this, over the last 2 years the Multi-Disciplinary Lung Cancer team at the North West Lung Centre, Wythenshawe Hospital have transformed the Lung Cancer Service with this pivotal key Programme.

This involved the complete redesign of the specialist and complex service, to what is now called the RAPID (Rapid Access to Pulmonary Investigation and Diagnosis) Programme. Central to the Programme is next day access to CT imaging following a referral for suspected lung cancer with same day hot reporting and clinical review with results dramatically enhancing the efficiency of the front end of the pathway.

Subsequently a coordinated pathway involving multiple tests is managed by the RAPID team ensuring multiple tests in a single visit where possible and daily review of investigation results eliminating unjustifiable delays. The programme has seen over 2,000 patients in its first two years with exceptional patient experience reported. The lung cancer pathway time has been significantly reduced with 45% of patients starting treatment within 28 days, 82% within 50 days and 94% within 62 days. NLCA 2018 positive outlier for 1 year survival.

Challenges:

The objectives of the RAPID Programme were to work collaboratively across departments and organisations to:

• Deliver cancer services we would expect for our own family with a ‘next day’ ethos and exceptional patient experience

• Potentially improve survival in lung cancer through rapid access to treatment and prevention of clinical deterioration on prolonged pathways

• Improve the overall quality of care, outcomes, booking system and processes.

• Reduction in investigation days with less patient visits to hospital.

• Measure the referral to date of treatment.

• Increase active treatment rates through prevention of deterioration whilst on the cancer pathway.

Lung cancer diagnosis is complex and requires multiple tests. Current cancer pathway targets set a maximum waiting time of 62 days from referral to treatment, yet also set a target of 85% compliance therein tolerating a longer pathway in one in seven patients.

Despite this, these targets are being universally failed across the UK. Lung cancer is the biggest cause of cancer death and has an aggressive biology. Rapid pathways that deliver a diagnosis and treatment well above that defined in the 62 day pathway will not just deliver the patient experience we would want for our own loved ones but may also improve survival.

Outcomes:

Programme successes:

• Exceptional and improved patient experience from the outset

• Positive shift in one year survival

• The lung cancer pathway time has been significantly reduced with 45% of patients starting treatment within 28 days, 82% within 50 days and 94% within 62 days.

• Elimination of two-week wait and 31 day breaches

• Increased the number of CT scans performed by day 7 by 3.5-fold to 92% of GP referrals

• Reduced the time from GP referral to outpatient clinic, with a fully reported CT scan, by 6 days, from an average of 10 days to 4 days.

• Increased number of MDT discussions by day 14 from GP referral, 5.25 fold (42%) and by day 21 by 4.5 fold (77%)

• Have been able to confirm the absence of cancer on the day of CT scanning, compared with an average of 6 days previously

Challenges included:

• For optimal efficiency and communication, attaining control over multi -departmental appointments is ideal. Collaborative working overcame some of the issues but sustainability is required moving forward.

• PET scanning: As no control over access and limited collaborative working hindered effective pathway planning and delivery. No PET provision on-site prevented same day planning for necessary tests. Discussions continue.

Spread:

The RAPID Programme is a proven, consistent and sustainable structured approach to lung cancer management in which, from conception to present day continues to address key issues in lung cancer diagnosis, treatment and ultimately survivorship, thus improving patient outcomes physically and psychologically.

RAPID can be replicated in the right centre and with the correct leadership and determination from the outset. In its infancy the staffing were employed on a temporary basis, however due to its success and these staff have now been made permanent proving that it is sustainable and changing the way the North West Lung Centre manages the disease, reduces variation and enabling a more timely cost effective diagnosis.

The team are keen to share their lessons learnt, successes and ultimately best practice for the RAPID Programme and therefore they have presented to groups and stakeholders (CCGs, patients, third sector etc), locally, regionally, nationally and internationally. Additionally, the North West Lung Centre has received visits from other teams in England, who are keen to transform their lung cancer service and learn about the exemplar and transformational Programme, enabling the sharing of best practice with a proven Programme and support wider adoption to improve outcomes across the UK.

Value:

The core aim of the RAPID programme was to speed up access to diagnostics, eliminate unnecessary delay and improve the patient experience for patients with suspected lung cancer. Prior to the RAPID Programme, from the 2 week referral, 0% of patients had their CT scan within 4 days, 27% had a CT scan within 7 days and 74% within 14 days.

However, post RAPID implementation, this now stands at 78% of patients have their CT scan within 4 days, 92% within 7 days and 99% within 14 days. We have shortened the diagnostic pathway for lung cancer such that 8%, 42%, and 77% of referrals are discussed at MDT with completed investigations by day 7, 14 and 21, respectively compared with 0%, 8% and 17% prior to the introduction of RAPID.

As a result, 40% of patients received surgery within 14 days of MDT and we are now working to robustly establish appropriate working practices within thoracic surgery and medical oncology to improve this even further. With 93% of patients rating the RAPID service as 8 out of 10 or better, this has confirmed an improvement and acceptable, accelerated service for the benefit of patients and their families.

Involvement:

All stakeholders have worked above and beyond to make the RAPID Programme sustainable, proven and a success.

Stakeholders include:

• The Health Foundation

• Patients and carers

• Manchester University Hospital NHS Foundation Trust (Specialist Thoracic teams including, Radiology, Pathology, Macmillan Specialist Nurses, Physiology, Physiotherapy, Management, Administrators)

• Manchester Health & Care Commissioning

• GPs

• Cancer Network

• The Christie

• University of Manchester

• Cancer Research UK

• Macmillan

• Roy Castle Lung Cancer Foundation Media coverage (aired and online) has included BBC and ITV news Regionally and Nationally, Manchester Evening News newspaper.