1 / 19

Diagnosing Cancer Earlier

Diagnosing Cancer Earlier . Professor Mayur Lakhani CBE FRCGP FRCP Cathy Hughes, Cancer Lead Edana Minghella, Project Manager Mayur.Lakhani@eastmidlands.nhs.uk. What we have done to understand the risks of cancer delay. Early priority for NPSA

Télécharger la présentation

Diagnosing Cancer Earlier

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.


Presentation Transcript

  1. Diagnosing Cancer Earlier Professor Mayur Lakhani CBE FRCGP FRCP Cathy Hughes, Cancer Lead Edana Minghella, Project Manager Mayur.Lakhani@eastmidlands.nhs.uk

  2. What we have done to understand the risks of cancer delay • Early priority for NPSA • Analysis of Patient Safety Incidents reported to the NPSA • Workshops using RCA/Fishbone • Focussed literature review • Work in progress, aim to finish Discovery Phase by March 09 and publish initial report

  3. Where do risks arise from? • +++ Patient Factors – symptom misattribution • +++ Doctor (GP) Factors – the diagnostic process (assessment, vigilance and failure to fast track) • +/++ System factors – waiting for tests and treatment

  4. The genesis of risk: emerging themes Dysfunctional communication Variable quality of general practice Organisational culture Test ordering, results management and follow up Fragmentation of care Failure to follow established procedures and guidelines - failure to fast track

  5. The patient experience

  6. Analysis tools Data Cleansing NRLS Database Reports & Analysis How are PSIs reported? 99% upload from your local trust reporting system eform

  7. General Practice and NRLS • Only contribute to O.4% total incidents in NRLS • General Practice has a separate system called Significant Event Auditing – informal, intra practice educational • QOF - 12 over 3 years including new cancer diagnosis • Huge variation in quality of SEA, little sharing of information, and low level of reporting into PCO, LRMS and NPSA NRLS • Greater standardisation

  8. Histology Communication Radiology reporting Preparation for tests Clinical assessment Test waiting times Surgical cancellations Administrative errors Test results not reported, reported incorrectly or reported after a long delay (many cases) Misfiling (many cases) Categories from NRLS- mainly secondary care data

  9. Test waiting lists First seizure 8th January; seen by GP 10th January; urgent neurology referral 11th January. Seen By Dr 19th March - MRI and fast track EEG requested; MRI 26th April - left hemisphere mass. results received by neurology Dept 15th May . Given to Dr 4.6.07; period of 5 months to diagnose brain tumour.

  10. Communication 28 year old woman was seen in out patients on 5th Oct as a new patient. No notes were available so the consulting doctor took notes on a pad and asked the secretary to make up a set of notes. The doctor ordered a biopsy, the results of which showed CIN3. A letter was dictated and this was left with the secretary to type and make a follow up appointment. The GP contacted the doctor on 9th June the following year to ask whether the patient had had any treatment; when the doctor investigated, it emerged the patient had not been seen since the OPA.

  11. Examples of guidelines not being followed (i.e. not fast tracked) • Iron Def Anaemia given parentral iron, not investigated = Bowel Cancer • Excision of Skin lesion, sample not sent for biopsy = Skin cancer • Recurrent rectal bleeding attributed to haemorrhoids = Bowel Cancer • Dealing with diagnostic ‘overshadowing’, Cancer in the patient with co-morbidity (e.g. anaemia in chronic disease)

  12. The case of children and young people – real life stories • 93% of 16 – 24 years olds with cancer and a similar proportion of parents of children with cancer surveyed by CLIC Sargent in 2007 said that increasing GP awareness of cancer to help speed up diagnosis was really important • Rare/Less common cancers • Generic solutions and tumour specific

  13. Practice Culture/Disempowered Pts. • Several visits to GP with same symptoms not noticed or acted upon • Patients return time and again and go to A&E but still don’t get help – may not complain or ask for a second opinion; accept a ‘passive’ role • Not enough time in the consultation to let the patient talk • Attitude: Example of one woman who felt she was ‘fobbed off’ –’neurotic’, ‘menopausal’ • Negative investigations but persistent symptoms

  14. The approach to improvement • Do not forget the positive stories!! Celebrate success • Astute GPs and patients (example) • GPs are part of the solution (but need to do some things better) • Important principle in patient safety: avoid blame and judgement, focus on improving systems • Medical errors are usually system related and preventable

  15. Context of Transformational Change and better models of care • HQCFA (Darzi) particularly fairness • World Class Commissioning • Doctor Quality – Appraisal and revalidation • Organisational Quality – CQC –risk management • Patient empowerment /Health space • Medical Leadership and integration of care • Quality Metrics and Accounts/ CQUIN

  16. Co-produce safety with patients

  17. Next Steps - We need results quickly 1. Patient Safety Campaign (‘Could it be cancer, doctor ?’) 2. Measurement and Benchmarking: Patient Safety Indicator of Total Delay 3. Better reporting and learning including - Significant Case Review (MDT reviews of T3/T4 tumours. RCGP National Audit in Primary Care 4. Define standards for the Education and Training in Cancer for GPs – Appraisal 5. Better models of care and push the boundaries of fast track e.g. 3 days – Improved primary care access to Imaging –Primary Care Oncology Initiative 6. Standards for Test ordering, reporting and management (CQC)

More Related