REDUCING TIME TO PALIATIVE RADIOTHERAPY
Higgins E, Caparros E, Sillman C, Foyle S, Thomas P, Banner R.
South West Wales Cancer Centre
AIM: 95% of patients receiving palliative radiotherapy (PRT) to be treated within 14 days of consent.
METHODS: Using quality improvement (QI) methodology, a process map was drawn up with stakeholders, areas of weakness identified and then organised in a driver diagram. A Pareto chart helped to highlight which part of the pathway would be most effective to address in achieving success. Run charts of the percentage of patients receiving PRT <14 days from consent were used to track progress
RESULTS:Between April 2016 & March 2017, 425 patients were treated with PRT. 108 patients were not treated within 14 days. The most common reasons for breaching were; plan not localised within 5 days; lack of machine capacity; machine breakdown; delayed planning CT. Using Pareto analysis to guide us (Fig 1), our interventions to address these included; increased awareness among consultants to reduce localisation time; 80% target for single fraction treatment of bone metastasis to improve capacity and streamlining of the pathway from CT simulator to localisation. Through these interventions, the proportion of patients each month receiving PRT within 14 days has increased from 58% to 88% though significant variation month to month has been observed (Fig 2). Despite monitoring, the precise changes most responsible for the improvement cannot be identified. With increased awareness of its importance, the whole department has worked with a clear sense of ownership towards improving standards. This itself is likely to be central to the progress made thus far, perhaps reflective of the Hawthorne effect. Pareto analysis consistently shows ‘time to localisation’ as being the main cause for a delayed pathway.
CONCLUSION:Using QI methodology has proved an effective way to improve the proportion of patients receiving PRT within 14 days of consent. The Cancer Centre is considering Advanced Radiographer roles to further decrease time to localisation for PRT.