Summary
The Scottish Cancer Treatment Helpline (CTH) initiative is pioneering as it is the only validated service in the UK to have competently trained non clinical staff to use the UKONS tool to triage patients following SACT/radiotherapy 24 hours a day. It has resulted in the delivery of a safe and effective method of identifying and assessing those patients who are at risk from life threatening toxicity from SACT/radiotherapy.
Challenge
A scoping exercise within Scotland’s three cancer networks found that the advice and help patients received during and following SACT/radiotherapy was inconsistent and unreliable.
NHS Boards must meet the neutropenic sepsis best practice. The Scottish Government chief executive also dictates compliance through CEL 30, requiring all Scottish health boards to develop pathways to enable patients’ access to timely advice, 24 hours a day.
The government set up a Short Life Working group (SLWG) consisting of experts from areas such as oncology, primary care, emergency medicine and NHS 24. It aimed to address identified safety issues, comply with the CEL 30 and ensure best practice for patients during and for up to 8 weeks after SACT/radiotherapy.
Objectives
The project had three objectives. Firstly, patients would have one telephone number, answered within a specific time to ensure a safe, efficient, high quality, patient centred service. Secondly, patients’ oncology assessment and intervention should be triaged to the most appropriate specialist for their location. Finally, patients who are not admitted, but present with symptoms, would be robustly followed up.
Solution
The SLWG developed a 24-hour cancer treatment helpline (CTH), based on the Edinburgh Cancer Centre (ECC) experience of using the UKONS tool with a mixed team of healthcare professionals (HCPs) and NHS24’s call operator experience. In addition the author/lead for the UKONS tool provided expert advice at various stages of development, implementation and evaluation.
A three-phase approach was adopted to provide a greater understanding of how it could be sustainably managed within local, regional and national contexts.
Before the launch, both boards held stakeholder events for HCPs. This was invaluable when setting up local infrastructures. The teams also developed efficient IT pathways for communication, publicity materials, patient alert cards, patient information leaflets, CTH and HCP education programmes.
The CTH launched in June 2013. The phased approach provided the opportunity to set standards which were audited to ensure, it was safe, efficient and patient-centred before launching in other boards.
Results
CTH outcomes reported to the Scottish Cancer task force in a six-month evaluation report found the service safe, efficient and patient-centred. Monthly reports submitted to the health boards covered call demand, calls answered, time to answer calls and triage outcomes.
Patients were positive about the service, describing it as highly accessible.
Locally agreed acute care assessment pathways meant that patients were not sent to their treating centre. This meant prompt assessment and intervention.
Data showed that nine per cent of calls were triaged to amber, meaning a follow-up call the following day from the CTH team. A fifth of the follow-up calls lead to an acute assessment due to deteriorating symptoms.
Learnings
The project showed the call operator model to be safe, efficient and effective for cancer patients.
The infrastructure developed to support initial implementation was invaluable in ironing out problems and developing the service. The daily partnership meeting, the development of a core clinical expert group, clear communication tools and a formal reporting processes all proved crucial.
IT processes were effective in providing effective IT communication pathways between NHS 24 and the health boards.
The project recommended that staff involved in assessing patients demonstrate their understanding of the purpose of the CTH.
Health boards presented local outcomes to clinical management teams, highlighting challenges in providing equity of care in different secondary care settings. Steps are being implemented to address these challenges.
Evaluation
There was concern that the CTH would increase acute service demands. Neither board found this to be the case.
Half of those assessed at NHS Lothian’s ECC and referred through the CTH were assessed and discharged. In NHS Ayrshire & Arran, the figure was 40 per cent. This may be because that in NHS Lothian the majority of patients are assessed by oncologists in a dedicated oncology assessment area.
Interim analysis of 12-month 30-day mortality suggests it has at least remained stable. Formal outcomes will be reported when this data has matured.
Since the launch patient calls have been more evenly dispersed over the week with out of hours calls increasing therefore life-threatening symptoms are potentially being diagnosed more promptly.
