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Lung Pathway Review 2 February 2011

Lung Pathway Review 2 February 2011. North Trent Cancer Network. Numbers Submitted. Source of Presentation. Discussion. Doncaster 74% Consultant Upgrade – Rotherham and Chesterfield 0% Chesterfield and Sheffield high 2ww Rotherham highest A&E admissions Barnsley ? Mixed GP & Routine (2WW)

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Lung Pathway Review 2 February 2011

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  1. Lung Pathway Review2 February 2011 North Trent Cancer Network

  2. Numbers Submitted

  3. Source of Presentation

  4. Discussion • Doncaster 74% Consultant Upgrade – Rotherham and Chesterfield 0% • Chesterfield and Sheffield high 2ww • Rotherham highest A&E admissions • Barnsley ? Mixed GP & Routine (2WW) Real differences or data quality?

  5. Treatment

  6. Discussion • Is there are variation in chemo practice? • Could more radiotherapy be used? – is Rotherham included in palliative – high A&E rates linked? Real differences or data quality?

  7. Pathways

  8. Barnsley – all patients Where an MDT took place

  9. Discussion • Average wait for 1st investigation = 17 days (assumed GP is 2ww) • Average wait between 1st and 2nd investigation = 7 days • Investigation to treatment decision longest period • Only 8 discussed at MDT? • Treatment not specified in data

  10. Chesterfield – 2ww patients Where an MDT took place

  11. Discussion • Average wait for 1st investigation = 14 days • Average wait between 1st and 2nd investigation = 9 days • 50% had 1 MDT, 22% had 3 or more • 3 breaches had not finished investigations by day 62

  12. Doncaster – 2ww and consultant upgrade patients Where an MDT took place

  13. Discussion • Average wait for 1st investigation = 5 days • Average wait between 1st and 2nd investigation = 2 days • 50% had 1 MDT, 22% had 3 or more • 5 breaches most had not got dtt by day 62

  14. Rotherham – 2ww patients Where an MDT took place

  15. Discussion • Average wait for 1st investigation =8 days • Average 1st – 2nd = 1 day • CT and bronchoscopy on same day • 75% had 1 MDT, 16% had 3 or more (surgery & chemo) • No breaches

  16. Sheffield – 2ww patients Where an MDT took place

  17. Discussion • Average wait for 1st investigation = 5 days • Average wait between 1st and 2nd investigation = 13 days • 12% had 1 MDT, 41% had 3 or more much more MDT discussion? • 5 breaches ? Average wait for 1st investigation = 14 days • Average wait between 1st and 2nd investigation = 22 days

  18. Average Days from Referral To 1st Treatment & 1st Treatment to 2nd Treatment Consultant Upgrade A&E

  19. Discussion • Doncaster & Sheffield significantly slower to 2nd investigation for consultant upgrade & A&E • Barnsley significantly quicker for consultant upgrade and A&E • 2WW – Doncaster & Rotherham quicker for 2nd investigation – average 7 & 9 days respectively with others being nearer 3 weeks (Barnsley max 24 days)

  20. Average Days Referral to Treatment No treatment data from Barnsley

  21. Discussion • Rotherham waiting longer for chemotherapy (small numbers or no local chemo)? • Need to understand Inter Trust Transfer – data does not tell us this - ideal pathway should be by day 28

  22. Investigations • Sequence 2ww patients (not Barnsley)

  23. Barnsley

  24. Chesterfield 2ww

  25. Doncaster 2ww

  26. Rotherham 2ww

  27. Sheffield 2ww

  28. Discussion • Generally sequence being followed • Chesterfield had a few bronch prior to CT • Only Sheffield using EBUS

  29. Investigations • Non 2ww patients (not Barnsley)

  30. Chesterfield Non 2 Week Wait Patients

  31. Doncaster Non 2 Week Wait Patients

  32. Rotherham Non 2 Week Wait Patients

  33. Sheffield Non 2 Week Wait Patients

  34. Discussion • More out of sequence but not many • Lot more investigations for this group of patients

  35. Discussion • Can all get to 2nd investigation by 2 weeks and how? • GP involvement improve this ? CT requests?? • Variation by oncology practice? (addressed by other future NSSG audits) • Consultant upgrades – consistency and streamlining them – how? • Role of MDT – variations in practice across the Network. When in the pathway do they need to be discussed – could decisions be made outside of the MDT to fast track investigations? • Role of EBUS – how will this impact once rolled out over Network?

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