Download Urology Specialist Team Measures as a PDF

ROYAL BERKSHIRE HOSPITAL
Report Type
Self Assessment
Trust
Guide
National Benchmark Position: Key
Overall Compliance (% score)
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ROYAL BERKSHIRE NHS
FOUNDATION TRUST
Service
This service
Highest Performing Team
Lowest Performing Team
Performance range for the
majority urology specialist
cancer services
Urology Specialist Team Measures
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National middle score
Publication Date 3rd July 2015
This benchmark is based on the 48 urology specialist cancer services
who have completed their assessment in 2015-2016
Quality and Performance Summary
Overall Compliance
Serious Concerns and Immediate Risks
A Serious Concern was identified when the service
was last assessed
86%
Self Assessment
SEE BELOW FOR PROBLEM RESOLUTION
No assessment took place in 2014-15 cycle
2015 Patient Experience Survey National Tumour Results
Patient understood what was wrong
Easy to contact CNS
Patient had confidence in doctors
Patient contact post discharge
Patient given enough care
The Service has a complete team
Members cover all relevant disciplines.
76%
85%
84%
90%
44%
Trust Results
2015 Patient Experience Survey Trust Tumour Results
Given complete explanation
Patient told sensitively
Treatment options explained
Patient involved in decisions
Taking part in research discussed
Waiting Times for Trust - All Cancer Services April - June 2016
71%
89%
91%
81%
12%
Any queries please contact [email protected]
Treated in targeted time
2 Weeks
31 Days
62 Days
92%
98%
82%
www.mycancertreatment.nhs.uk
Structure and function of the service
Measure
There is a lead clinician and the core team includes all relevant members
Each role needs to attend 95% of the MDT meetings
MDT will discuss the treatment plan of all patients
All MDT core members attend two thirds of the meetings
There are additional members who don't need to attend as part of the core team
Operations and post operative care take place on a single hospital site
Surgeons meet the required minimum workload
The MDT discusses the reuired number of patients a year
Met
Y
N
Y
Y
Y
N
N
Y
The MDT is led by Mr Adam Jones, Consultant Urological Surgeon. 2013 was a difficult year for the local
MDT members with regard to their SMDT input. The RBH local MDT raised concerns at the SMDT peer
review in 2013 and as a result the SMDT was put on immediate risk. Since then one of the RBH
consultants has relocated and the 2 senior WPH consultants have resigned. Everyone agrees that the
SMDT is now functioning very well.
The MDT has a complete and diverse core and extended membership. Improvements this year have
included the very successful repatriation of WPH cystectomies to the RBH site, the successful introduction
of robotic cystectomy and robotic partial nephrectomy and excellent National Cancer Patient Experience
Survey results.
All major cancers are covered by at least two consultant members. The four CNS and one Macmillan
sponsored nurse practitioner provide comprehensive supportive services to patients greatly enhancing the
quality of their holistic care.
The MDT meets every Wednesday morning from 8.00am until 9.30am. The first part of the meeting is
devoted to the sMDT and then the other local cases. Last year only one meeting was cancelled because
of the British Association of Urological Surgeons annual meeting. All core members attended at least 66%
as evidenced by the weekly attendance records of the meetings.
An annual operational meeting is held (last meeting June 18th 2014) and the operational policy is
continuously evolving.
The 2 week and 31 day targets were met last year and the 62 day target was only very narrowly missed.
(see below).
Two week wait 94.3% (Target 93 %)
Thirty one day wait 97.5% (Target 96 %)
Sixty two day wait 83.2%. (Target 85 %)
Any queries please contact [email protected]
www.mycancertreatment.nhs.uk
807 cases have been discussed at the MDT of which 389 were new cases. 969 Two-week-wait flexible
cystoscopies have been performed. 301 Two-week-wait trus biopsies of the prostate have been
performed.
Members of the MDT participate actively in the sMDT and also the PbODG (provider based operational
delivery group) the successor of the network TSSG meetings.
Coordination of care/patient pathway
Measure
Network agreed clinical guidelines are in place
There is a regular clinic for patients for prostate
There is a regular clinic for patients with blood in their urine
Patients are encouraged to discuss their treatment options with the MDT
Network-agreed patient pathways are specified
MDT agrees an individual patient's treatment plans
Lead clinician attends at least two thirds of the network group meetings
Met
Y
Y
Y
Y
Y
Y
Y
The MDT chairman ensures the role of the MDT is in full accordance with guidelines Network guidelines
are contributed to (i.e. this year the RBH MDT were responsible for updating the guidelines with respect to
prostate cancer) and these guidelines, are based on those laid out by the European Association of
Urology.
MDT discussions are recorded as formal minutes and a copy of patient consultation letters are offered to
all patients. All new patients with a diagnosis of urological cancer are discussed in the MDT (irrespective
of age and stage of disease).
All patients who fulfil the criteria for sMDT discussion under IOG are referred to that meeting. All patients
are allocated a named key worker and a written confirmation of this is placed in the patients notes.
Patient Experience
Measure
A key worker is in place
MDT provides written material for patients and carers
The patient is offered a record of the consultation
MDT looks at patient feedback in the last two years and act on at least one point
Met
Y
Y
Y
Y
The RBFT are a national site for the enhanced recovery programme. The urology team runs a very active
Any queries please contact [email protected]
www.mycancertreatment.nhs.uk
prostate and a separate bladder cancer support group and this year we are planning to introduce a kidney
cancer support group. Support group initiatives include arranging meetings with patients who have
previously undergone treatment and also for prostate cancer visiting the department to specifically look at
the robot and brachytherapy set ups. Many members of the support group are now active fundraisers for
us.
Specific service improvements relating to patient experience have included; The introduction of a one stop
cystectomy clinic for patients referred from WPH. We appreciate that although single site surgery is an
IOG requirement, it does have some inconvenience to patients coming from WPH so for those patients we
have introduced a dedicated clinic where they meet the surgical and anaesthetic team, the local CNS
team, stoma therapists, pre-operative clerking and visit the ward all in one visit.
This is the 3rd successive year that RBH has scored highest of all the Thames Valley urology
departments in the National Cancer Patient Experience Survey. Highlights included
Q 15 Patient given a choice of different types of treatment? RBH 96 % (nat ave 91 %).
Q21 Patient given the name of the CNS in charge of their care? RBH 98 % (nat ave 88 %).
Q38 Patient had confidence and trust in all doctors treating them? RBH 96% (nat ave 87 %).
Examples of ‘anything good?’ responses in the National Cancer Survey include;
“During my stay in RBH and follow up appointments, I have always been treated
with the utmost respect and dignity by both doctors and nurses, also HCA”.
“I receive very personal attention in a friendly
and welcoming environment. I do not believe I would have been similarly
treated elsewhere except, perhaps at the Royal Marsden Hospital. Hence I am
reluctant to move away from the Reading area”
“My care and treatment has been first class at all times”.
“Yes. From initial GP referral to surgery was just 3 weeks. Most impressive. I
was seen by a hospital doctor who referred me for a CT scan. I was then seen by
another doctor in urology who notified me of the diagnosis and arranged for me
to undergo surgery just less than one week later during which period, I
underwent pre-op assessment. The speed and efficiency with which I was
treated was beyond my wildest expectation. Absolutely first rate”.
Areas where we were below national average have been discussed at an operational meeting and
addressed in the work plan
Any queries please contact [email protected]
www.mycancertreatment.nhs.uk
Clinical Outcomes
Measure
MDT reviews clinical indicators and/or audit data each year and discuss at the network
meeting
MDT produces an annual report on clinical trials and discuss with the network group
Met
Y
Y
In this year the team have performed 68 nephrectomies and partial nephrectomies, 67 radical
prostatectomies and 33 radical cystectomies. The team have also completed 56 surgical prostate
brachytherapy procedures. There has been one death after a prostatectomy and one death after a
cystectomy.
100% of new cases were discussed at the MDT or sMDT and 100% of new cases see a CNS prior to their
treatment.
National database and local audits have demonstrated very good results;
1. Nephrectomies : BAUS national audit data shows that compared to national average the RBH rates of
1. complications, 2. transfusions, 3. mortality are all lower than national average. Furthermore these
results are achieved with a case mix that appears more difficult than average. For RBH patients WHO
performance status >=2 is 66 % compared to 10 % nationally. Patient age > 70 is 36 % (30 % Nationally)
and below normal Hb pre-op 42 % vs 33 % nationally. The median LoS is 3d ( 4d nationally).
2. Prostates; BAUS data shows that RBH is at the higher end of the distribution for numbers of
procedures performed. T2 positive margin rates are regarded as a marker of technical proficiency. The
national average is 13.5%. RBH rates are around 10 % (full audit in process).
3. Partial nephrectomies. Since changing from open partial nephrectomies to robotic in April 2014 there
has been 1. Less blood loss 400 ml vs 620 2. Less reduction in post op renal function. 3. Reduced length
of stay 3.5 d vs 6.5d and 4 . Greater proportion with no complications (Clavian 0 ) 75 % vs 55%
4. Cystectomy since repatriation (April –Dec 2014 including robotic cases).
1. < 500 ml blood loss 72% (nat ave 23 %). 2. Not transfused 89% (nat ave 43 %). 3. Average LN count
22 (nat ave 8). 4. Average Length of Stay 6 (nat ave 15).
5. Cystectomy patient satisfaction survey since repatriation (initial results n =14).
1. Were you involved as much as you wanted to be in decisions about your care and treatment? Yes,
definitely 93%
2. Did you have confidence and trust in the doctors treating you? In all of them 93 %, In some of them 7%.
3. Were you able to discuss any worries or fears with staff during your hospital visit? As much as I wanted
93%.
The team have an ongoing prospective data collection programme on all major surgery and review
Any queries please contact [email protected]
www.mycancertreatment.nhs.uk
complications according to the Clavian system.
There is always a trials nurse at the MDT meeting and the team actively recruits to national trials including
RADICALS, STAMPEDE, GENETICS study as well as undertaking local trials in collaboration with
pharmaceutical companies e.g. Enthuse.
STAMPEDE
Pt approached 18
Pt recruited 4
RADICALS
Pt approached 3
Pt recruited 1
UK Genetics Prostate cancer
Pt approached 22
Pt recruited 7
UK Genetics Testicular cancer
Pt approached 21
Pt recruited 12
Good Practice
The major achievement of 2014 has been the improved IOG compliance with a very successful
repatriation of cystectomies to RBH. Coupled with this and following personnel changes the SMDT is now
a well functioning unit. In addition highlights included;
• Passed case number 650 in brachytherapy
• Excellent National Cancer Patient Experience Survey results (best in Thames Valley for third year
running)
• Continued development of RFA as a treatment option for small kidney tumours.
• Introduction of robotic cystectomy and robotic partial nephrectomy.
• Successful incorporation of Mr Paul Hadway as new cancer consultant
Any queries please contact [email protected]
www.mycancertreatment.nhs.uk
Immediate Risks
No Immediate Risk was identified
Serious Concerns
Cystectomies are now done at a single site and work is in progress for prostatectomies to move across to
RBFT for a 6 month period. Whilst it is recognised that this is improving, it remains a serious concern until
all urological cancer surgery is done at a single site.
No Serious Concern Resolution was identified
Other Concerns
General Comments
No general comments given.
Any queries please contact [email protected]
www.mycancertreatment.nhs.uk