Screening for gastrointestinal cancer can often involve procedures to directly inspect the gut with a flexible telescope (colonoscopy or gastroscopy). Not all patients are suitable for such invasive tests, which do carry a small risk of harm, therefore, patients are traditionally reviewed as part of a face-to-face clinical appointment prior to requesting such tests. At DBTH, patients could wait for up to two weeks before they could be seen for this first step, a knock-on of which could mean that individuals could wait for around four to five weeks before gaining a diagnosis of, or excluding, cancer.
With carefully and recently designed pathways of care, it is now possible for the majority of these patients to be triaged and assessed by a dedicated Advanced Nurse Practitioner within three days of referral by telephone. In this manner, the waiting times for diagnostic tests has been brought down to around two weeks, roughly half of what it was for many patients, with around 300 patients benefiting from this way of working each month.
The pathway was first developed in 2019 for patients with suspected cancer of the lower bowel (colon and rectum) and proved instrumental in maintaining these cancer services during the COVID-19 pandemic. Although waiting times remained challenged due to the disruption created by coronavirus, colleagues at the Trust are starting to see things return to normal and have recently observed a 20% increase in performance against monitored monthly standards.
Due to this success, in September 2021 the Trust expanded the pathway to introduce the ‘Straight To Test’ pathway to Upper Gastrointestinal Cancers of the stomach, gullet, pancreas and liver.
The pathway is triggered by an urgent referral made by a GP, with a telephone consultation from the hospital taking place between one and three days after. Patients, if appropriate, are then sent straight for an appropriate diagnostic test (including one or more of a colonoscopy, gastroscopy or CT scan), which may take place between three and 14 days, depending on current demand. Most patients will have cancer excluded at this test and will be informed on the same day, having their all-clear diagnosis by the recommended 28 days from referral. Those patients who are diagnosed with cancer, can move onto further staging tests more quickly, with the aim to discussing a potential treatment plan in the relevant multi-disciplinary team meeting within four weeks of referral.
Speaking about the new way of working, Mr Tim Wilson, Consultant Surgeon, said: “Throughout the past few years, we have worked extremely hard to speed up the cancer diagnostic pathway, whilst ensuring that it remains safe and effective. This work has only been possible with the hard work and collaboration of individuals working across many different departments. It has been particularly challenging to introduce innovations such as this throughout the pandemic, which has forced us to think and work in different ways. However, as a Trust, we are absolutely committed to delivering the very best service for our patients and I am hopeful that the valuable lessons we have learnt throughout this process can be applied elsewhere.”
Lesley Barnett, Deputy Director of Nursing for Cancer at the Trust, said: “Illnesses such as a cancer can create an understandable amount of anxiety within our patients, therefore it is incredibly important that we continue to improve and innovative wherever we can. The Rapid Diagnostic Service is all about tightening up our process, enhancing services wherever possible and ensuring that our residents have access to testing within appropriate timeframes. We are making fantastic strides locally, and I hope this will continue long into the future.”
Similarly, the Trust has recently received £230,000 from the South Yorkshire and Bassetlaw Integrated Care System to establish a Community Diagnostic Centre (CDC) at Montagu Hospital. One of only two such facilities in the region, the CDC which is currently in phase one of its development seeks to improve patient service by creating a one-stop-clinic for a variety of tests and consultations for illnesses such as suspected cancers, as well as the diagnostics outlined above. In early January and February, a CT Suite and MRI Scanner were placed at Montagu Hospital. Together it is envisaged around 2,600 patients will be seen within the Mexborough site, significantly reducing the local backlog of people awaiting further tests.