Download Supporting Scotland`s first 24 Hour Cancer Treatment Helpline in a

Supporting Scotland’s first 24 Hour
Cancer Treatment Helpline in a
Regional Cancer Centre
Jackie Whigham, Project Manager for Acute Oncology and Caroline McKinnel, Lead Nurse Chemotherapy Quality.
Edinburgh Cancer Centre.
Introduction
Evaluation
Recent reports(1) and guidance(2) have highlighted that failure to provide
access to timely advice and assessment for patients receiving systemic
anti cancer therapy (SACT)/radiotherapy potentially compromises patient
safety. Chief Executive Letter 30(3) (CEL30) states that all Scottish health
boards must develop pathways which enable patients access to timely
advice and assessment 24 hours a day.
In addition to meeting the challenges, evaluation has been built in by:
1.Measuring the impact through audit: Analysis of 12 month data has
demonstrated a variety of benefits including;
1.Provide 24 hour telephone triage for patients receiving SACT/
radiotherapy at the Edinburgh Cancer Centre (ECC).
2. Develop local assessment pathways for patients living within and out
with the Edinburgh Cancer Centre.
3.Develop a seamless communication process for recording outcomes
following triage.
The Response
1.The Edinburgh Cancer Centre joined the Scottish Cancer Treatment
Helpline (CTH) in June 2013, (Figure 1).
2. Local assessment pathways were implemented with additional follow
up service for patients whose symptoms require assessment, but who
do not need to be admitted to hospital.
3. A seamless internal process implemented to ensure clinical prescribers
have up to date information, (Figure 2), following CTH triage.
• Local assessments, (Figure 4)
• Reduction in number of patients requiring admission following
assessment, (Figure 5).
2.Capturing the experience of patients and Health Care Professionals
(HCPs): Patients were positive describing it as highly accessible and very
reassuring. The HCPs interviewed were supportive of CTH and positive
about the direction in which it was developing.
Figure 3: Day of week patients call.
20
Percentage (%)
The Challenge
• Calls now consistently spread evenly over the week, (Figure 3)
15
5
0
Patient is managed
according to
triaged alert
Green =
Self Care Advice
Amber =
Thu
Sat
Sun
27
13
10
D&G
Other
Forth
Valley
Fri
1548
400
199
ECC safety check:
1. CTH outcome
2. Acute care outcome
198
31
Lothian
Fife
West Borders
Lothian
Location
Assessment required
within secondary
health care setting
Figure 5: Number of CTH patients discharged following assessment.
80
Percentage (%)
Completed tool is
electronically auto –
shared with the
prescribing and
primary care team
Figure 2: Chemocare where outcomes are documented.
Wed
800
0
Double Amber
or Red =
INFORMATION FOR AMBULANCE
If patient well on arrival
or refuse to travel
contact CTH number above
Tue
1200
Follow up within
24hrs CTH team
Cancer Treatment
Helpline
0800 917 7711
Mon
Day of the Week
Number of Patients
Front End:
24 hour Cancer Treatment Helpline
CTH Call operator
triages patients
symptoms according
to the UKONS tool
with Immediate Life
Threatening questions
1st and access to
order 999 Ambulance
Poly Post CTH
10
1600
Patient is triaged
using UKONS tool
Pre CTH
Post CTH
Figure 4: Assessment location (July 2013 – June 2014).
Figure 1: CTH model which uses UKONS tool to triage(4).
Patient at home
has a health
concern
Poly Pre CTH
70
% Calls sent for assessment
60
50
% Discharged following assessment
40
30
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Day of the Week
Summary
Developing the infrastructure to support the CTH within the ECC has been
a significant piece of work. As a result patients with SACT/radiotherapy
related toxicities now have access to a more robust, consistent and
equitable 24 hour triage, and those who require it have access to effective,
timely assessment near to home. Clinicians/prescribers have up to date
information in relation to outcomes following CTH triage. Most importantly,
both patients and healthcare professionals are in agreement that this
change represents an improvement in the care received by patients with
cancer. The CTH service will be rolled out throughout Scotland by the end
of 2014.
References: (1). National Confidential Enquiry into Patient Outcome and Death report: Systemic Anti-Cancer Therapy: For better, for worse? (2008). http://www.ncepod.org.uk/2008sact.htm. (2). Assessment, Diagnosis and Management of Neutropenic Sepsis –
Best Practice Statement. http://www.scotland.gov.uk/Topics/Health/health/cancer/publications/bestpracticestatement. (3). Chief Executive Letter 30. http://www.sehd.scot.nhs.uk/mels/CEL2012_30.pdf. (4). UKONS Rapid Assessment and Access Toolkit – Evaluation
Report 2010. http://www.ukons.org/docs/24%20evaluation.pdf