LUCADA RBH Experience

1
LUCADARBH Experience

• Nancy Horseman,
• Cancer Information Manager
• The Royal Bournemouth Christchurch Hospitals
  NHS Trust
• Lucada Early Adopter

2
Participation

• Another hoop despite lack of staff, lack of time,
  inadequate local tools?
• A national solution! We were committed and keen.

3
Background

• My mother was diagnosed with small cell lung
  cancer the day I found out I was pregnant with my
  first child
• She died 9 months later
• Who do you know?

4
Project History at RBH

• Lung cancer audit commenced in 1999 as a
  cross-district project
• Data collection based around core minimum dataset
  published by Mick Peake in 1999 with addition of
  locally identified data items
• Measurement against British Thoracic Society
  standards

5
RBH Project History Cont.

• Funding for continuation of audit allocated to
  individual Trusts end 1999 facilitator employed
  for 22 hrs p/w (transformed to MDT Facilitator
  post in 2002, 30 hrs p/w)
• RBH developed home-grown in-house lung cancer
  database in Microsoft Access

6
More RBH Project History

• Dataset updated at various stages to accommodate
  new requirements
• Dangers of DIY
• PMI link written
• CSV uploads written for Cancer Waiting Times
  (CWT) and LUCADA

7
Identification of New Cancers and Treatment
Details

• MDT referrals
• Copies of letters from Thoracic Consultants,
  Surgeon, and Oncologists sent to MDT Facilitator

8
Identification of New Cancers and Treatment
Details

• Histo-pathology reports, collected daily from
  Histo-pathology department by Cancer Waiting
  Times Facilitator, distributed to MDT
  Facilitators
• Relevant cytology reports sent to MDT Facilitator
• Monthly spreadsheet from Information Department,
  entered by coders on PMS

9
LUCADA/CWT and MDT

• Newly diagnosed patients and newly treated
  patients are routinely discussed at the MDT
  meeting (99.4), providing the ideal opportunity
  to capture audit and CWT data
• Patients receiving on-going care are also
  discussed, enabling capture of treatment and
  follow-up data

10
Prior to the MDT Meeting

• MDT referral forms sent to MDT Facilitator
  (completed by clinical team members) and details
  entered onto database
• Consultant Physician reviews referrals and
  casenotes for each patient discussed at MDT and
  completes MDT proforma (printed from database)
• Database record updated

11
During the MDT Meeting

• Summary displayed on screen at MDT meeting
• The facilitator records results of investigations
  and management plans
• Data entry is proofed and approved by MDT
• The facilitator notes which patients are relevant
  for data collection (eg new diagnosis, new
  treatment, follow-up, not applicable)

12
Following the MDT Meeting

• MDT summaries signed by Nurse Specialist, faxed
  to GP and filed
• Data collection completed from MDT summaries,
  letters and hospital patient management system
  (eCaMIS)

13
Prior to Upload

• Queries run to identify patients awaiting
  treatment or completion of audit data
• Check queries run to ensure data completeness

14
Best Practice

• High proportion of patients discussed at MDT
  meeting (99.4)
• Completion of MDT Summary by Consultant Physician
  prior to MDT meeting and display of summary at
  meeting
• MDT Summary updated to included relevant LUCADA
  data fields, previously difficult for Facilitator
  to collect FEV1/, Co-morbidity, Performance
  Status, Stage

15
Best Practice

• Letters and investigation results available on
  PMS/eCaMIS
• Links with Facilitators in other hospitals to
  obtain details of treatment received
• Receipt of coded information from Information
  Department
• Receipt of copies of histology/cytology reports
• CSV upload from database

16
Difficulties

• Inaccuracies of CSV upload, some manual entry
  required (subsequent lack of confidence in CSV)
• Certain data items
• Time! (Staff illness)
• Balance between MDT and data collection

17
Benefits

• Audit as part of clinical practice
• Uniform data collection facilitates network-wide
  audit
• Comparative results
• Readily available reports

18
Developments Awaited

• Presentation of results
• Measurement against nationally agreed standards
• Completion of audit cycle
• Identification of problem areas and improvements
  made
• Celebrate success