developing a localised lung cancer referral and diagnostic pathway in a regional setting

Stephen Manley

Cancer Systems Innovation Manager

NNSW LHD

Lisa Delaney

Project Officer: Lung Pathway Project

(Mon & Wed)| NNSW LHD

Lung Cancer Pathways Project:

Local referral and diagnostic pathway

implementation for lung cancer

NNSWLHD Pilot site

Lung Cancer Pathway Project Overview

Statewide project

Project collaborators

– Cancer Service Innovation Managers (CSIMs) Community of Practice (CoP)

– Cancer Institute NSW

– University of Sydney Research in Implementation and eHealth Group (RISe)

– Local Health Districts (LHDs)

– Primary Healthcare Networks (PHNs)

– Lung MDTs

Lung Cancer Pathway Project Overview

Strategic objectives of the NSW Cancer Plan 2011-

2015:

Improving the survival of people with cancer through

the reduction in variations in cancer outcomes across

NSW, reducing the gap between evidence and clinical

practice and reducing the gap between evidence and

policy.

A Toolkit has been funded and developed

Toolkit

Development

Application by non-pilot LHDs

Application to other cancer

sites in the future

Optimal Care

A number of organisations have

developed ‘ideal’ pathways.

‘Optimal Cancer Care for People

with Lung Cancer’ pathway is the

‘National work plan for improving

care in Australia.’

NNSW LHD role

Northern NSW LHD, alongside Sydney South

West LHD, has received funding from Cancer

Institute NSW as the regional pilot site to develop

a referral and diagnostic pathway for lung cancer.

Toolkit: Test and QI .

Mapping current pathways and identification of

barriers to an optimal pathway.

Project Collaborators

Expert Advisory Group:

Professor Tim Shaw (co-chair)

Ms Kahren White (co-chair)

Mr Paul Bennet (HealthPathways Project)

Dr Kate George (GP)

Ms Jill Lack (Newcastle CSIM)

Professor Jane Phillips

Dr Nicole Rankin

Dr Emily Stone (Respiratory Physician, St Vincent’s

Hospital)

Rise

Cancer Institute NSW

University of Sydney

2 pilot LHDs

Project Process

Obtained from lung cancer

pathways toolkit

Current Progress

Stakeholders have been identified and engaged

Continual presence at MDT meeting for ongoing

engagement

Mapping current service is underway

Patient audit to enhance current pathway mapping has

been completed and patient interviews to follow

Stakeholder Engagement

NNSW LHD contains 2 lung MDT groups – Lismore and

Tweed

Mapping Meeting

Service Mapping

Patient Audit

Case 1 = 88 days to treatment

GP

•15/6 CXR Mclean

•26/6 CT Grafton

•30/6 Referred

32d Resp phys

•17/7 consult

•30/7 PET CT

EBUS

•CROSS BORDER

•CG Hospital

•3/8 Referred

Resp Phys

•21/8 consult with EBUS results

•13/8 DOD

MDT

•2/9

Treatment

•11/9 Rad Onc consult

Patient AuditCase 1 = 88 days to treatment

GP

•15/6 CXR Mclean

•26/6 CT Grafton

•30/6 Referred

32d Resp phys

•17/7 consult

•30/7 PET CT

EBUS

•CROSS BORDER

•CG Hospital

•3/8 Referred

Resp Phys

•21/8 consult with EBUS results

•13/8 DOD

MDT

•2/9

Treatment

•11/9 Rad Onc consult

Private

Rooms

Paper

RecordPaper

Record

Paper

Record

Power

Chart

Paper

Record

Power

Chart

Power

Chart

Patient Audit

Case 2 = 14 days to treatment (Palliative case)

GP

•14/8

11d Med Onc

•25/8 Consult

•3/9 CT Biopsy

•2/9 PET

•24/8 DOD

1d ED

•26/8

2d Rad Onc

•28/8 consult

Treatment

•28/8

MDT

•2/9

Patient Audit

Case 2 = 14 days to treatment (Palliative case)

GP

•14/8

11d Med Onc

•25/8 Consult

•3/9 CT Biopsy

•2/9 PET

•24/8 DOD

1d ED

•26/8

2d Rad Onc

•28/8 consult

Treatment

•28/8

MDT

•2/9

Power

Chart

Paper

Record

Private

RoomsPower

Chart

Patient Audit

Case 11 = days

GP

•No record - cross border

MDT

•27/7

•CT

•PET

Treatment

• Surgery

•No record - cross border

Power

Chart

Challenges finding information

Paper record

Private practice information

Information sources

End Product

Establish the preferred pathway utilising information

gathered from stakeholders.

Gain consensus on the preferred pathway from

stakeholders

Utilise Health Pathways to promote the established pathway

to GPs in NNSWLHD

End Product

Advantages

– Awareness

– Avoid delays

– Minimise learning curve

Further work

Established tools to be utilized in other LHDs to develop

their local lung cancer pathway

Utilisation of tools developed to be transferable to other

cancer sites in the future

Stephen ManleyCancer Systems Innovation Manager

NNSW LHD

Locked Mail Bag 11, Lismore 2480

Tel 02 6629 4524 | Fax 02 6620 2355

Mob 0414 662 302

stephen.manley@ncahs.health.nsw.gov.au

Lisa DelaneyProject Officer: Lung Pathway Project

(Mon & Wed)| NNSW LHD

Locked Mail Bag 11, Lismore 2480

Tel 02 6629 4547 | Fax 02 6620 2355

Lisa.delaney@ncahs.health.nsw.gov.au

Lung Cancer Pathways Project

Local referral and diagnostic pathway

implementation for lung cancer

NNSWLHD Pilot site