Systems improvement for faster cancer treatment at Wairarapa DHB

With its relatively small population, Wairarapa DHB is not a cancer treatment centre, but local people can be certain they have access to the same range and quality of cancer services as patients in larger urban areas.

New initiatives are improving the timeliness of diagnosis and treatment, as well as improving the support provided to patients and their families.

The introduction of cancer care coordination by a specialist nurse and the implementation of the DHB’s Faster cancer treatment project has allowed a fresh look at systems and clinical pathways.

Patients who need radiotherapy or chemotherapy travel to a neighbouring DHB for their treatment and some investigations, such as specialist imaging, are also provided by other DHBs. One of the roles of Jacinta Buchanan, the cancer nurse coordinator, is to assist patients in navigating what can be a complex treatment environment.

Jacinta is the ‘go to’ person at Wairarapa, providing support and information throughout diagnosis and treatment, including when patients are transitioning to a treatment centre or new team. She links the patient and their family to some of the wider support team, including social workers or community oncology nurses or Cancer Society volunteers. A newly introduced psychosocial assessment also helps gauge the support patients and their families may need.

Jacinta maintains an open door policy – patients can contact her anytime during work hours. Typical questions asked include:

  • ‘How long until I can get to see the medical oncologist?’
  • ‘If I’ve seen a surgeon here do I have to see another surgeon at the treating DHB?’
  • ‘Is there any assistance to get to Wellington for imaging procedures and /or treatment?’
  • ‘Who will support me when I get back to the Wairarapa?’

With patients often being looked after by several teams in different locations, good IT systems are essential. At the outset when a patient is referred to the DHB by their GP, the referral is received electronically. A triaging system has been established by the hospital specialists, ensuring that any patient with a high suspicion of cancer or a confirmed cancer diagnosis can be allocated an appointment within 2 weeks. After a year of using this system an awareness of cancer requiring urgent attention is now part of the DHB culture and practice.

The patient’s journey is managed by a clinical tracking system, overseen by the nurse coordinator with 24 ‘trackers’ who have access to patient information and can input data electronically throughout the patient journey. Members of the tracker team are all involved in the patient’s care and can monitor the patient’s progress as well as adding information, such as diagnostic work up and treatment schedules, without having to transfer paper files or trying to find team members by phone. Simply put, each person involved in a patient’s care is assigned a task and a time frame and the nurse coordinator checks daily that all tasks are being attended to and follows up any that are not. A clinical tracking template is completed once the patient receives their first treatment. 

Wairarapa patients are also part of the sub- and regional treatment teams, involving many specialists including pathologists, radiologists, oncologists, surgeons and physicians. An important forum for planning treatment and care is the multidisciplinary meeting held by videoconference each week with Capital & Coast DHB and/or Midcentral DHB.

These meetings bring together all the staff involved to review care planning and treatment, saving patients unnecessary appointments and lengthy travel. For example, when a patient needs both radiotherapy and chemotherapy, all the pathology and imaging results are presented to the multidisciplinary team at the same time allowing them to compare opinions and come up with a recommended best treatment plan that can start immediately.

The combination of initiatives allows patients to benefit from better, faster cancer treatment, regardless of where they live.

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