Improving Head & Neck Cancer Network Imaging Efficiency, Experience and Cost Through Mobile Applications and Pathway Optimisation
Chrysostomos Tornari, Akshaya Rajangam, Milad Golshafiri, Dhulshan Preena, Philip Touska, Steve Connor,
Richard Oakley & Asit Arora
Department of Head & Neck Surgery - Guy’s & St Thomas’ NHS Foundation Trust
Head and Neck services aspire to rapid radiological diagnosis to optimise cancer outcomes and improve the patient experience. Imaging pathway errors can cause delays in cancer diagnosis and significant financial losses. Furthermore, they constitute a sub-optimal use of radiology and radiography resources. In order to reduce delays, we identified areas for improvement and changed our pathway protocols.
In the first phase, a week-long multidisciplinary meeting (rapid improvement event) was conducted to create a streamlined imaging requesting protocol. This updated and standardised protocol was converted into a cross-platform mobile app. The app was circulated to the multidisciplinary team and supplemented with posters, emails and educational talks. A number of same-day appointment slots for CT and MRI were also created.
Imaging was found to be the most common reason for diagnostic delay in our population.
CT was the most common modality for which imaging was delayed, followed by MRI and PET-CT.
Clinicial Survey on Imaging Requesting Confidence
We surveyed clinicians that request imaging in our department. Our integrated department comprises ENT, OMFS and Oncology-trained doctors ranging from Foundation Year Trainees to Consultants.
Our survey showed that clinician confidence in imaging requests varied according to clinical scenario. Furthermore, heterogeneity in imaging modality selection was worse according to the rarity of the presentation, as shown in the examples below.
Conclusions and Future Directions
Imaging delays lead to slower patient diagnosis and multidisciplinary planning in our experience. A prospective audit of Multidisciplinary Meeting discussions and repeat online clinician survey is currently in completion to assess the impact of our changes.