SELF ASSESSMENT REPORT (MULTI-DISCIPLINARY TEAM) Network Trust MDT MDT Lead Clinician GMCN ROYAL WOLVERHAMPTON HOSPITALS The Royal Wolverhampton Hospitals Trust Lung MDT (11-2C-1) - 2011/12 Dr Angela Morgan Compliance Self Assessment LUNG MDT 85.2% (23/27) Key Themes Structure and function of the service The named Lead Clinician for the MDT is Dr A J Morgan. The core and extended membership of the MDT is discussed and detailed within our Operational Policy and Annual Report. However, briefly, the MDT consists of the following core members: - Respiratory Consultant - Consultant Clinical Oncologist - Consultant Medical Oncologist - Consultant Cardiothoracic Surgeon - Consultant Radiologist - Consultant Histopathologist/ Cytologist - 2 Clinical Nurse Specialists The MDT meets weekly on Tuesday afternoons at New Cross Hospital, with 51 meetings taking place over the past year. Approximately, 20 patients are reviewed at the meetings each week, and this number is continuing to increase. A total of 685 patients were discussed with 1099 discussions in the lung MDT in 2010 (NB some patients are discussed more than once) compared with 791 discussions in 2008 and 1006 in 2009 Over the past year, there have been 730 new referrals (via Fast Track, Internal, Emergency & Other) Fast Track referrals - 297 Internal referrals - 274 Emergency & Other referrals - 159 The MDT is still struggling to meet the national target of 62 day compliance despite extensive SELF ASSESSMENT REPORT for The Royal Wolverhampton Hospitals Trust - Lung MDT (published: 7th October 2011) Page: 1/7
scrutiny on a regular basis. Data has shown that compliance against this measure stood at 74.2% against the national target of 85% - this equates to 24 breaches for the year. Further detailed figures are presented within our Annual Report. The majority of the breaches attributed to RWHT are due to a complex pathway. Common themes for delay include: - Patients having to be admitted for diagnostic investigations. - In-patient's not being well enough to undertake diagnostic investigations. - Multiple diagnostic investigations are being performed due to initial investigations not yielding positive histology. - Clinical Trials are also impacting on the actual treatment dates due to consent process and clinical needs. - Tertiary referrals to RWHT also impact heavily on the Cancer Waits Target. - Intersite referrals are impacting when patients are being dual investigated. The aim of the MDT is to ensure a well co-ordinated, seamless approach of diagnosis, treatment and care planning to patients diagnosed with lung cancer and mesothelioma. The MDT is committed to providing rapid communication to other professionals who may come into contact with the patients throughout their journey. The Royal Wolverhampton Hospital NHS Trust has the following facilities for lung cancer patients- - A two 28 bedded respiratory wards - A purpose built state of the art Heart and Lung Centre- lung cancer clinics and cardiothoracic clinics are held immediately after the MDT on Tuesday afternoons - A purpose built Radiology Department offering interventional radiology such as CT, MRI, CT guided Biopsies, Ultrasound FNA. - - An Endoscopy Unit which carries out Bronchoscopies and pleural biopsies twice a week and now includes an EBUS service - The Deanesly Centre- housing the Oncology clinics, chemotherapy unit and radiotherapy unit - The Macmillan Support and Information Centre available to all patients and carers offering up to date information on benefits and services available to patients diagnosed with lung cancer - A F/u telephone service for all patients with a diagnosis of lung cancer or mesotheliomaappendix thirteen - Monthly support group meetings for patients and carers - Active research group entering patients into a variety of studies, including new chemotherapeutic agents/regimes and management of pleural diseases. Members of the RWHT Lung MDT attend the NSSG meetings. The NSSG met four times in 2010-2011 and 100% cover was provided by RWHT. Coordination of care/patient pathways Referrals are made via the GP to the Fast Track Centre as per the standard pathway for patients with suspected lung cancer. All CXR's requested via the GP are checked by dedicated Radiographers. If a CXR is felt to be SELF ASSESSMENT REPORT for The Royal Wolverhampton Hospitals Trust - Lung MDT (published: 7th October 2011) Page: 2/7
indicative of lung cancer, the Radiographers will book a CT scan and refer the patient into the Fast Track Centre. Patients identified as having possible lung cancer on the basis of an abnormal X-ray in other departments i.e. Accident and Emergency, are referred into the lung cancer service via the fast track system. In-patients are managed by the respective medical team, and are referred to the appropriate specialist team to assist with the patient management. The Fast Track Team normally contacts patients to offer them an appointment to see the Respiratory Physicians. If this is not acceptable to the patient a second appointment will be offered (ensuring this is within the two week referral time frame). At this time, a CT scan may have already been requested either by the GP or through the radiology department The MDT co-ordinator along with the Fast Track Team will monitor the patients progress relative to the 2 week Fast Track Referral and 31/62 day waiting time target. Referrals to the MDT are managed by the MDT co-ordinator who receives referrals either via the telephone, email or proforma's. The MDT discusses and reviews the management of all new patients with suspected lung cancer. Treatment and planning decisions are made on the basis of the individual needs of the patient concerned and according to local and national guidelines. Treatment plans are recorded in the patient's notes and on the Live Somerset Cancer Register. The treatment plan will be discussed with the patient and their families at the next out- patient appointment. The patient can request a copy of the discussion whereby the treatment plan is set out at the consultation. At this consultation, written information is made available to patients and carers to cover their condition and possible treatment options, information about local services, contact numbers and contact with the Clinical Nurse Specialist. It is seen as best practice to book patients into clinic on the same day as the MDT to inform the patients of the discussion; however this is not always possible. Referrals to surgeons often take place in the MDT and supported by a letter at the time of clinic.referrals to the cardiothoracic surgeons will be equitable and fair thus a rota for referral for diagnostic investigations, resections and specialist surgery has been produced. Further communications will be undertaken with the surgical co-ordinator to ensure this process is as seamless and effective as possible and thereby reducing the waiting times for the patients. Referral to Oncology will be carried out via the MDT, and supported both by a proforma and a letter of referral via the clinic. This will be done within 24 hours of the patient being told of their intended treatment plan. An appointment to see the Oncologist will often be within one week. If this cannot be achieved, ad-hoc clinics are established so that patients are not delayed in being seen, or receiving treatment such as chemotherapy or radiotherapy. It is seen as best practice for the patient to be given the appointments in clinic for the oncologists so that patients are aware of dates and have time to plan. Those patients suitable for clinical trials will be discussed with the Oncologist at the first appointment. Research nurses are also present at the first appointment. The MDT works to the agreed Network guidelines. SELF ASSESSMENT REPORT for The Royal Wolverhampton Hospitals Trust - Lung MDT (published: 7th October 2011) Page: 3/7
Patient experience Obtaining patient feedback: A patient focus session was carried out with the support group in January 2010. This provided the following information - Positive areas: - Information was clear and concise and given at the time of diagnosis - Support from the CNS and medical team - Non clinical information available for carers - Patients and carers feel supported with telephone follow up service Areas for improvement: - Choice of what information to give - Plan of action with dates for appointments Following the group focus session the following actions have been implemented - Pathway of referral to the MSIC - Oncology appointments given the day of diagnosis or within 24 hours - New telephone follow up service offered to patients throughout their journey Patient Satisfaction Survey: The survey was sent out to 43 patients over the period of March 2011. The patients surveyed were selected to cover surgery and chemotherapy as treatment modalities. In summary - 49% response rate - Overall majority of responses were either strongly agreed or agreed to - Patients were advised of delays in clinic accordingly - Improvement re: summary of consultation letters offered - Patients feel that treatment options were discussed with them - Comments included impressed with Heart & Lung Centre/Surgical Team The MDT also took part in the National Cancer Patient Experience Programme "2010 National Survey". Conducted by the Quality Health, the survey was designed to monitor National progress on cancer care, following the launch of the Cancer Reform Strategy in 2007. The information captured in the survey will be used to help drive local quality improvements. In several areas the Trust scored in the top 20% of the UK hospitals. Areas of outstanding achievement mainly centred on the provision of patient information and support.51 patients responded for lung. Overall the results were positive for the lung team and scores were well SELF ASSESSMENT REPORT for The Royal Wolverhampton Hospitals Trust - Lung MDT (published: 7th October 2011) Page: 4/7
above average on the majority of subjects Clinical outcomes/indicators Clinical Lines of Enquiry: The LUCADA data has been presented within the MDT's Annual Report. The MDT has concerns regarding the accuracy of the data, particularly regarding bronchoscopies, CT scans and histological rate. The MDT will work with RWHT's Cancer Services Team in order to improve the quality of the data. This will then enable the MDT to undertake a meaningful analysis of the results. Mortality and Morbidity post within 30 days of treatment: It is seen as best practice to regularly discuss mortality at the MDT if a core member feels it is necessary. At present, individual directorates hold regular Mortality and Morbidity meeting to discuss and collate all deaths. In the respiratory directorate, this is then fed back to the respiratory governance meeting and is a standard item on the agenda. Research and Clinical Trials: 2010 has shown New Cross Hospital to be one of the highest performing centres to recruit patients into clinical trials. RWHT recruitment figures- 1st April 2010-31st March 2011 Fragmatic= 11 T-frag=1 Time 1=7 MALCS= 7 Fortis-M=6 FUM=17 Boehinger Pro1=2 Meso=5 TCD=4 TOTAL=34 An educational day will take place each year to up date the MDT on new treatments in each modality including new clinical trials. Audits: Audits are undertaken as part of clinical governance and in accordance with NSSG requirements. The following audits are carried out annually SELF ASSESSMENT REPORT for The Royal Wolverhampton Hospitals Trust - Lung MDT (published: 7th October 2011) Page: 5/7
- GP Communication - Patient satisfaction survey, the Trust is also taking part in the "Cancer Patient Experience Survey Programme" 2011. - Pathway audit/ 31-62 day audit- see annual review plan In 2010-2011, the MDT also completed the following audits: The Role of Bronchoscopy in Diagnosing Lung Cancer, Endobronchial Ultrasound Audit, Lung Cancer Surgical Resection Audit The network audits as proposed in the lung NSSG Work Plan 2010/2011 are: - Radical radiotherapy Audit- the final part of the data has been received and the audit is to be presented at the NSSG meeting - Surgical Resection Rate Audit- This is still ongoing As part of the GMCN, RWHT are also due to take part in the EGFR and PET Audits. Good Practice Good Practice/Significant Achievements Key Achievements: - 100% attendance at NSSG meetings by a member of the core team at RWHT - Appointment of a new respiratory consultant and lead for lung cancer - 51 Lung MDT meetings held in 2010 - High recruitment into NCRN trials - Extensive access for patients to new drugs in development through commercial trials - Collaborative working across all modalities of care including introduction of defined surgical referral pathway to ensure equitable distribution of cases amongst surgical colleagues. - Full integration into the MDT of Somerset Cancer Register to collect live data - Collection of data for NLCA (National Lung Cancer Audit) - Annual Education and Review Meeting held at RWHT for the second year running - Ongoing success of patient support telephone calls - Monthly support group now in its second year - Regular involvement of a physiologist for spirometry in the lung cancer clinic, including a dedicated lung function slot each week for patients requiring full lung function testing prior to surgery/ radical radiotherapy - Participation in the local "Early Detection of Lung Cancer" and national "Improving Lung Cancer Outcome Project" - Fully operational with EBUS service at RWHT - Participation in the "National Cancer Patient Experience Programme 2010 National Survey" - Introduction of a fortnightly pleural service at RWHT Concerns Immediate Risks SELF ASSESSMENT REPORT for The Royal Wolverhampton Hospitals Trust - Lung MDT (published: 7th October 2011) Page: 6/7
Serious Concerns Concerns General Comments The Lung MDT underwent a formal internal validation peer review assessment (with a properly convened IV panel) on 07/07/11. A full IV report regarding the Lung MDT will be issued by the Trust. Organisational Statement I, Dr Angela Morgan (Lead Clinician) on behalf of ROYAL WOLVERHAMPTON HOSPITALS agree this is an honest and accurate assessment of the Lung MDT. SELF ASSESSMENT REPORT for The Royal Wolverhampton Hospitals Trust - Lung MDT (published: 7th October 2011) Page: 7/7