Systems Improvement for Faster Cancer Treatment at Lakes DHB

Lakes DHB provides care to a population of around 100,000 in the Rotorua and Taupo districts. Around 18 patients each month are diagnosed with cancer during an acute presentation to hospital and, on average, seven or eight are referred to hospital with a high suspicion of cancer.

Local patients travel to the regional cancer centre at Waikato Hospital for specialist oncology services, such as radiotherapy and inpatient chemotherapy, while patients requiring urological procedures are treated at Bay of Plenty DHB, and advanced gynecological procedures and neurological procedures are provided in either Hamilton or Auckland.

Some chemotherapy is administered as an outreach service at Rotorua Hospital and Waikato oncologists also offer follow up clinics at Rotorua, but many cancer patients will have their appointments and treatments in more than one location.

The DHB has a number of initiatives in place to help ensure Lakes patients get the coordinated and timely care they need throughout the cancer pathway.

A new electronic system collects information from the various DHBs so that patients can be tracked during their treatment. Information can be entered by cancer nurse coordinators and data is also uploaded automatically into the database either nightly or weekly, depending on the source.

The system allows named clinicians to monitor their patients progress through the system and helps the DHB meet the 62-day target for first treatment. A traffic light colour-coding system allows easy visibility of the patients’ journey, while another report identifies any missing information.  The system also allows information to be viewed by tumour stream as well as observation of variance between ethnic groups.

Lakes clinicians – generally heads of department – who are accepting referrals and triaging patients have developed documentation to identify referrals where there is a high suspicion of cancer or confirmed cancer, or where a patient needs to be seen urgently.

Initiatives to speed up access to appointment are also being put in place in various specialties. Respiratory physicians have set up an urgent process to ensure patients can have CT scans prior to a first appointment for local patients and on the same day for out-of-town patients. A process is being developed to allow direct referrals from GPs and other specialists to colonoscopy, and a colorectal specialist nurse has been appointed to work with the surgeons to fast track patients with the highest risk for cancer.

GPs can also make direct referrals to the minor operations lists for melanoma, with the triaging surgeon deciding between a specialist appointment or direct access to the minor operations waiting list where they generally receive treatment within two weeks.

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