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Martin Walshaw



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    OA05 - Increasing the Impact of Nursing and Allied Health Professional Interventions in Lung Cancer Care (ID 130)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Nursing and Allied Professionals
    • Presentations: 1
    • Now Available
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      OA05.05 - Transforming the Patient Experience in Lung Cancer Through the Use of Clinical Nurse Specialist Virtual Clinics - The Liverpool Experience (Now Available) (ID 2130)

      15:15 - 16:45  |  Author(s): Martin Walshaw

      • Abstract
      • Presentation
      • Slides

      Background

      To improve the patient experience in lung cancer, in 2014 we introduced to the UK the concept of “virtual” clinic working, where following secondary care review of suspicious CT scans taken in the community a lung cancer nurse specialist (LCNS) conducts a clerking/holistic assessment via telephone and offers an investigation plan where appropriate.

      In 2017, this model of care was adopted into UK National Lung Cancer Optimal Pathway guidance.

      We were interested to review the effect of our innovative service on patient experience.

      Method

      We looked at patient feedback, staff perceptions and impact on the lung cancer pathway of our virtual clinic 2016-18.

      Result

      Of the 1498 patients with a suspicious CT scan, over 75% were diagnosed with cancer.

      Overall 802 (70%) were diagnosed via the outpatient service and 705 (88%) chose virtual clinic assessment and diagnostic test facilitation.

      Qualitative audit has shown an overwhelmingly positive feedback, where 98% of users felt that the virtual clinic was a better option, and patients felt well informed and supported.

      In addition the LCNSs feel they are utilising their knowledge and skills in a more timely fashion with an appropriate population. The early assessment facilitates the start of that therapeutic relationship that leads to patient needs being addressed, symptom management advice, reducing distress and optimising patient performance status and quality of life.

      Furthermore ‘virtual’ working has seen a dramatic reduction in medical outpatient activity, allowing that resource to be used more efficiently for the benefit of cancer patients.

      Conclusion

      This service review has shown that the data and patient and staff experience all support this new model of care delivery.

      The benefits are multifocal: care is patient-centred , appropriate skill-set use improves staff morale, and the freeing up of infrastructure allows organisational resource reallocation and cost saving.

      We have advocated the role of the LCNS to take the lead in this model of working across the UK, as we feel the LCNS are best placed to do these sensitive and complex assessments.

      We welcome the opportunity to share our experience worldwide.

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    P1.07 - Nursing and Allied Professionals (ID 171)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Nursing and Allied Professionals
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.07-04 - Early Lung Cancer Team Intervention in Emergency Admissions (Now Available) (ID 919)

      09:45 - 18:00  |  Author(s): Martin Walshaw

      • Abstract
      • Slides

      Background

      The Liverpool Lung Cancer Unit is a unique diagnostic service diagnosing approximately 430 patients per year. Although the majority of cases of suspected lung cancer can be managed as outpatients where the diagnostic pathway is well developed, a proportion still present unwell via the emergency department where their subsequent journey is less certain. Along with same-day reporting for emergency scans, we have developed a rapid review service for such individuals and were interested in assessing its performance.

      Method

      We looked at all patients with suspected lung cancer who presented through our emergency department at The Royal Liverpool University Hospital in 2018, focussing on outcome, time to be seen following admission, and the histological diagnosis rate.

      Result

      Of the 561 referrals to our lung cancer unit, 196 (35%) presented through the emergency department: 73 (37%) were discharged to outpatient cancer investigation. The remaining 123 (63%) were admitted to 26 different locations (8 medical specialities, surgical, vascular and orthopaedic wards).

      Of these, 72% were seen by the lung CNS within one working day and appropriate management initiated. This was aided by our live CT scan database, where 69/79 (87%) were coded on the same day. Daily CNS checks of the database ensure early inpatient identification and review by the lung clinician and CNS, often before formal referral from the responsible clinical team is made.

      Overall 103 patients (84%) who presented as emergencies subsequently were diagnosed with a malignancy. 96 were diagnosed with a primary lung cancer of which 56 (58%) had histological confirmation.

      Conclusion

      Our results show that, by coordinating care between the emergency and radiology departments and the lung cancer team, patients presenting unwell can be managed rapidly even if they remain in hospital. In addition, by actively seeking them out we can not only provide them with timely and appropriate investigations but also early CNS intervention, facilitating symptom management, the opportunity to maximise their performance status and offer psychological support to not only the patient but to their families as well.

      This approach also ensures that the managing medical teams are given the right information from a specialist team. The Lung Cancer Team resource is therefore focussed on looking after lung cancer patients and those patients that do not have cancer but are referred to the team are informed at the earliest opportunity and treatment decisions made accordingly by the team responsible for their care.

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    P2.05 - Interventional Diagnostic/Pulmonology (ID 168)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Interventional Diagnostics/Pulmonology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.05-07 - The Liverpool "Straight to CT" and "Virtual Working" Lung Cancer Pathway – 5 Years On (Now Available) (ID 909)

      10:15 - 18:15  |  Author(s): Martin Walshaw

      • Abstract
      • Slides

      Background

      Streamlining the diagnosis of lung cancer is pivotal to improving outcomes and thereby the quality of the patient journey. As part of this, in 2014 Liverpool introduced the concepts of “straight to CT” (where patients with suspicious imaging or symptoms have a directly arranged rapid [< 72 hours] CT scan), and also the “virtual assessment” service (where those with scans suggestive of lung cancer are contacted by a lung CNS and the initial clerking and investigation planning is made by telephone) into its lung cancer diagnostic pathway This pathway is now in its 5th year and we report our experience.

      Method

      As regards “straight to CT”, there has been no increase in the demand for outpatient scan capacity for suspected lung cancer (about 400 scans per year). Patients with scans arranged in primary care without suspicious changes remain in the community, but those with other changes can be referred to a general chest clinic (21%). Of those who enter the virtual assessment pathway, 81% are diagnosed with lung cancer.

      Result

      To date, approximately 1200 patients have been through the “virtual assessment” service. Audit has shown that 98% prefer telephone assessment rather than physical clinic attendance, and most wish to be called on the same day as the scan. Patients feel that they had been given correct and timely information and feedback from primary care colleagues is uniformly positive. Lung CNS job satisfaction has improved since skills are now focussed more appropriately.

      Although the cancer unit diagnoses about 400 cases per year, using the virtual working model means that on average only 7 physical patient clinic attendances per week are necessary to provide the service, thereby greatly reducing resource use, saving 40% of costs overall. Furthermore, the more efficient service easily exceeds the 14 and 62 day cancer targets (99% and 97% respectively).

      Conclusion

      Many lung cancer services are now moving towards “straight to CT” and virtual working models. Our experience is positive, and we would recommend its adoption.

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