1081
Number of appointments
Number of patients seen
99.20 %
Pleased with initiative
Pleased with initiative
99.30 %
Happy with care
Happy with care
Background
In September 2022 The Surgical Consortium (TSC) were approached by the Department of Dermatology at a trust to assist with their increasing backlog of skin cancer patients. This included both patients on the admitted PTL waiting for surgery, and new 2 week-wait (2WW) patients with suspected skin cancer.
The Challenge
The Dermatology department had a failure rate of circa 62% of all 2WW patients. Of those that had already been diagnosed with skin cancer, the majority were rapidly approaching the treatment breach date. The existing pathway meant that patients requiring surgery were added to the Trust’s waiting list for surgery, with the majority of ‘urgent’ patients waiting more than 6 weeks for surgery, and non-urgent patients waiting for anything between 3 months to over a year.
The Approach
In this context, TSC proposed & agreed a new treatment pathway to minimise the impending breaches and reset the clock on the 2WW patients to zero. Over a 10-day period (5
weekends) 806 new skin cancer referrals were seen, with 70% of them being discharged or treated on the same day, and the remainder being operated on within a week. Using this ‘one-stop see and treat’ clinic model, the patients had their initial appointment with our Consultant Dermatologist and surgery with our Consultant Plastic Surgeon on the same day. We also carried out our own histopathology, and all results were reported and available on-average within 72 hours. Patients were therefore seen, diagnosed, operated on and given results within a week of their initial appointment with our Dermatologists. The 2WW compliance improved from 38% to 100% within this period.
Our teams also conducted all administrative duties, including booking patients, liaising with GPs and sending results to patients, and provided all nursing and ancillary nursing support as well as a weekly dressing clinic service. Patients requiring referral to the Trust MDT were made via the Trust skin cancer MDT coordinator, and were attended by TSC surgeons and pathologists to discuss specific cases and to make onward referrals for melanomas, sentinel lymph node biopsies, radiotherapy and long-term surveillance.
Summary
The success of this project was due to a number of factors:
• Our clinical teams consist of senior NHS Consultant Dermatologists; Plastic Surgeons, Dermatology Nurses and CNS.
•Treatment pathways were executed with GIRFT-aligned principles, thereby preventing unnecessary operations
on benign lesions, delaying definitive surgery by booking patients for diagnostic biopsies, and having the
confidence to discharge patients appropriately rather than bringing them back for multiple appointments.
• Clinics were arranged in a lean manner, having clinic rooms next to the minor ops suites so that patients could be moved from diagnosis to surgery seamlessly by
our clinical coordinators.
• Multiple parallel clinics and surgical lists were conducted on the same day, which meant that over 150 new patients were seen and treated each weekend, with those requiring surgery receiving their operation on the same day.
• The Laboratory Information Management System (LIMS) was integrated with our systems, allowing real-time histopathology reporting, consultant review, categorisation and subsequent discharge or onward referral, all of which was executed in an automated workflow.
•“Did Not Attend” (DNA) rates were less than 1%, largely due to the patient self- booking technology, allowing for patient choice and high-volume concurrent appointment bookings dealing with last minute cancellations.
Feeedback from both patients (PREMs) and clinicians was excellent, and we have since implemented similar ‘one-stop’ models in other Trusts.
