8 A decade ago, the RFL committed to a new approach in the UK – clinical practice groups (CPGs): clinician-led groups responsible for defining clinical standards, redesigning patient pathways and reducing variations in care across the trust’s hospitals. From those early scoping days, we have seen thousands of CPG-led improvements to patient care and the work continues. There are currently 106 pathways across RFL, 44 of which are digitised, and we continue to step up pathways at North Mid and across the trust. The results have been phenomenal. For cardiovascular, one of the trust’s clinical priorities, the inpatient heart failure digital pathway delivers consistently lower inpatient and 365-day mortality rates compared to the national average. Thanks to the pathway, which was launched at BH in 2019 and at RFH in 2021, the mortality rates have dropped from 14.6% to 9.5% at BH and from 9.0% to 5.1% at RFH. For patients admitted with a primary diagnosis of heart failure, the mortality rate has dropped by more than 40%. The success of the pathway – which utilises an automated blood test referral to the heart failure team to rapidly diagnose or rule out heart failure, close telemonitoring and safely and quickly increasing medication doses to target levels – has encouraged other trusts to trial it, with NHS England including it as part of their pathway blueprint for use across the country. Nearly every single one of our patients has benefitted in some way from our CPG work. There are the patients team if they are not filled by 1pm. The collaboration between the respiratory and nuclear medicine teams enables patients to have PET/CT scans much earlier in their lung cancer pathway, resulting in multiple benefits, including a dramatic improvement in waiting times. At the beginning of January last year, only 4.7% of patients were being seen and had their scan reported by day four. At the beginning of this year, 47% are being seen and their scan reported by day four – a tenfold increase. Additionally, there are now just 5% of patients waiting more than 10 days to start their treatment – last year that figure was 76%. Dr Anant Patel, lung cancer pathway lead, said: “This collaborative approach between the respiratory and nuclear medicine teams has delivered brilliant results. We are now the top-ranking trust in London and top five in England for our lung cancer 62-day wait.” More rehab for patients RFL is committed to providing data for more than 50 national audits with data requirements often changing every year. Despite having an established electronic patient record (EPR) system, the majority of audits are still undertaken manually, with information transcribed from EPR to the audit platform. Building on the success of the chronic obstructive pulmonary disease and adult asthma CPGs, the cardiac rehabilitation CPG has been working with the EPR change team and clinical medical information officer with a specialist interest in data to deliver more than 95% of data items required for the National Audit for Cardiac Rehabilitation CPG by automating data extraction from EPR. Since last summer the team has been able to accurately and reliably achieve this for more than 90% of the data items, with the remaining 10% on its way. As a result of the extra time released – 50 clinical hours a month – the team have already been able to significantly increase the number of cardiac rehab sessions they can offer. Rachael Brady, CPG programme manager, said: “The aim is for this to be replicated for as many other audits as possible giving even more of our staff additional time to spend with patients.” Tick Tock! Test it. Write it. Right Away All wards, except ICU and maternity areas, are taking part or will take part in a diabetes CPG 12-week improvement programme. The aim is to improve clinical outcomes by significantly reducing time to corrective treatment for hypo/hyperglycaemia and reducing the amount of time a patient’s blood glucose is not in range to avoid deterioration in health. At the start of the project, more than 50% of patients were not having their blood glucose levels documented on EPR within three minutes of the test being carried out and more than 5% weren’t having who go home sooner after hip or knee replacement surgery – currently an average reduction in length of stay from 4.5 days to 3 days, with the team now focused on moving to 0-1 night stays, which is currently already being achieved by 20% of our patients. There has also been a reduction in neonatal unit admissions from 8.3% to 6.8%. That’s more than 300 babies able to remain with their mothers, who previously would have been admitted to a neonatal unit. Kam Kalirai, director of CPGs, said: “From induction of labour to frailty and virtual care, our CPG success story keeps on going and growing, delivering better outcomes for our patients, value for money and staff satisfaction.” Sharing some of our recent successes A 10-fold improvement The 62-day pathway for suspected lung cancer is a fasttrack process from urgent referral through a diagnostic phase which involves rapid investigations to confirm lung cancer, including CT and PET imaging, biopsy procedures, blood tests and lung function assessment. To increase next day availability of PET/CT slots two morning slots are now protected five days a week for use by these BH and RFH patients. To minimise risk of unused slots they revert back to the nuclear medicine their test result recorded until more than an hour afterwards. Better access to work-stations on wheels (WOWs), a prompt by the glucometer to “document now” and using the data to give feedback to staff about patient outcomes are all being harnessed to embed swifter reporting as business as usual. The results are still being analysed but early indicators show a significant improvement in prompter documentation. Prostate CPG pathway improvement While the prostate pathway was initially developed eight years ago, there have been so many iterations in that time that some of the benefits have been realised just recently. At the start it was a disjointed pathway with patients being discussed at multiple multi-disciplinary meetings. This transitioned to a “one-stop model” which addressed some issues. But it was mapping and protocolising the process that gave the team the confidence to develop a nurse-led pathway which has brought a number of improvements, including freeing up consultant time without compromising on clinical care. The success of this has led other services to consider whether a nurse-led pathway could work for them too. The colorectal team are currently looking at ways of involving clinical nurse specialists more in the delivery of the two-week wait colorectal cancer pathway. Ann Woodward, CPG programme manager, said: “We’ve achieved the 62-day target every month since last November and our nurse-led clinics free up consultant time to deliver improvements and efficiencies elsewhere in the system. We’re now working with North Mid to standardise the pathway there and sharing the learning nationally.” Celebrating 10 years of clinical practice groups 9 10 Kam Kalirai Staff from the lung cancer pathway and nuclear medicine are successfully fast-tracking patients
RkJQdWJsaXNoZXIy NTI5NzM=