Colorectal Dissection Reporting A Role for Biomedical Scientists

1
Colorectal Dissection / Reporting A Role for
Biomedical Scientists

• Phil Hall
• Workforce Development Project Manager
• Avon, Somerset Wiltshire Cancer Services

2
Proposal

• An Advanced Practitioner role responsible for
  the dissecting and reporting of colorectal cancer
  specimens and reporting of tissue retrieved in
  future colorectal cancer screening programmes

3
Context

• Recruitment of Histopathologists and Biomedical
  Scientists
• Poor career progression leading to loss of
  skilled staff
• Introduction of National Colorectal Cancer
  Screening
• Changing Workforce Programme Pilots

4
Those Involved

• Senior Biomedical Scientists experienced in
  routine dissection
• Colorectal Specialist Consultant Pathologist
• Lead Colorectal Surgeon

5
Model for Improvement
What are we trying to accomplish?
Goals and aims Measurements and
reporting Change principles
How will we know that a change is an improvement?
What changes can we make that will result in the
improvements that we seek ?
Testing ideas before implementing changes
6
Training Development

• Develop dissecting skills to include colorectal
  resection specimens
• Training in reporting
• Non-malignant disease (polyps)
• Royal College of Pathologists Minimum Datasets
  for cancer

7
Training Methods

• Observation
• Supervised learning
• Unsupervised action with review
• Pathology mentoring
• Theory
• National Total Mesorectal Excision programme

8
Dissection

• 27 observed Consultant dissections
• 13 supervised BMS dissections
• 28 unsupervised BMS dissections
• Digital images taken to record each dissection
  procedure

9
Review

• All cases jointly reviewed with reference to
• Anatomy texts
• Digital images
• Microscopy
• Journal Papers
• Multi-Disciplinary Team Meetings

10
Audit

• Biomedical Scientists retain a working log of
  all cases including digital images showing
  evidence of learning, problem areas and errors

11
Outcome

• All cases pre-screened by Biomedical Scientists
  providing a report including minimum data set
  completion and staging
• Case reviews take place with the consultant when
  reporting. Minimum data set signed off by the
  consultant

12
Next Steps

• Continue with dissection
• Further develop theory and microscopy
• Refine audit and training methodology (use of
  improved software imaging systems for dissection)
• Liase with Royal College Training School Lead re
  standard training for SHO/Advanced Practitioners

13
Recipe for Success

• Commitment from all staff in Unit
• Protected time for training
• Support from professional bodies

14
Sustainability Spread

• Funding
• Backfill
• Training Courses
• Transferability
• Competency
• Accreditation
• Understanding what has been done
• Buy in
• Professional Bodies
• Trust Management
• Colleagues

15
Acknowledgments

• Dr J Sheffield, Medical Director, United Bristol
  Healthcare NHS Trust
• Mr G Sweet, Laboratory Manager, East Somerset NHS
  Trust