Summary
The multidisciplinary team in the Radiotherapy department at St James’ Institute of Oncology in Leeds has pioneered an innovative project to ensure instantaneous receipt of patient referral forms from across the Yorkshire Cancer Network for radiotherapy treatment.
The team has worked collaboratively to project manage and sucessfully implement a fully integrated electronic referral system that has customised existing software and interfaces with other hospital systems. This cost-neutral project has completely replaced paper-based referrals with a more robust, safe and efficient electronic system. The new system is more cost effective and will enable futher developments to increase efficiency and workflow modelling.
The project was designed and promoted using an iterative model of software development to analyse requirements, design functionality, implement solutions, evaluate and then repeat the cylce. Throughout, the team worked tirelessly with different hospitals and disciplines to deliver this innovative project to a successful conclusion.
The work was shared with the wider radiotherapy community and the impact of this project is becoming widely recognised, with a number of centres requesting to come and see how the project was developed and implemented.
The huge success of the project is a direct result of the innovation, creativity and determination of the multidisciplinary radiotherapy team at Leeds.
Challenge
These objectives were achieved by:
Multi disciplinary team initially mapping the Radiotherapy booking process identifying time lines and handovers in the process.
Engaging the key people with the appropriate skills and influence for example IT skills, data expertise, medical leads.
Developing a project plan and scoping the work.
With extensve consultation with the site specialist consultants, developed a ‘Booking form/ referral template’ within the Patient Information system (MOSAIQ)
Customising the existing software and redesigning the functionality of the system to support electronic referrals and remove all paper.
Consultation undertaken with the software manufacturers to ensure no compromise of the product.
Identifying and problem shooting the IT interface issues with other hospital Trusts across the network to ensure secure and consistent transfer of patient data.
Presenting project objectives and timecsales to peers and consultant colleagues and underpin with scheduled training sessions to support the transition from paper to electronic booking. Undertaking scheduled training of booking office clerks and secretaries on new system.
Phased rollout and introduction of electronic booking across all site specialties and consultants was documented and widely distributed.
Project reviewed at completion along with lessons learned.
Objectives
Manual completion of the radiotherapy booking form (referral) and the numerous handovers required to deliver it to the radiotherapy booking office resulted in a slow, inefficient booking process that reduced the quality of our servcie in terms of speed of access and delivery of cancer treatment. The multidisciplianrty team set out simply to achieve the following:
Introduce an electronic radiotherapy referral system that would increase speed of referral, reduce risk and more effectively and efficiently use the functionality of the radiotherapy Patient Information system (MOSAIQ) as a complete patient management system. As such it would be the first true electronic integrated referral system of its kind in the UK for a radiotherapy centre.
Results
The steps of the radiotherapy referral process have been reduced from 24 (max) to 12 with further initiatives planned to reduce this to a 4 step process.
Referrals for radiotherapy are now received instantly upon completion of the electronic referral forms. The system is available via a remote desk top session so that consultants can access the booking templates from anywhere in the Yorkshire Cancer Network and beyond as long as they have internet access. They can also remotely alter or delete referrals if required and these changes are auditable.
The patients demographics are automatically pulled through and appear on the referral form which saves the clinician time and eliminates a port for error.
The centralisation of the referral in a shared system enhances team work and efficiency. For example consultant completes a referral form in the peripheral clinics and the registrar in the cancer centre can see instantly how the consultant wants to treat the patient (or if there has been any amendments to the management) and can prescribe the radiotherapy without having to retrieve a paper booking form.
The IT interfaces have been set up and are consistent and secure. There have been no referral forms lost or delayed since the inception of the new system.
Evaluation
The instant receipt of referral forms is the the best measurement of the success of this project, eliminating up to a 4 day delay.
Perfomance against cancer wait targets.
All clinicans are now completing electronic referral forms.
Ceasing the use any paper referrals.
There have been no lost /delayed referrals due to the safety features built into the system
The system has been used to audit process and identify and eliminate the bottlenecks.
Feedback from the system users ie clinical oncologists, Nurses, Cancer target trackers and Secretaries has become positive.
Innovation
It is the first truly fully integrated electronic booking system that has facilitated increased efficiency, safety and security allowing cancer patients to be more rapidly referred into the radiotherapy service. It has been embraced by the software developers who are supporting the department to share the innovation and initiative with other radiotherapy centres across the UK.
This project has required no capital or revenue costs but has made major service improvements and helped make financial savings in lines with the Trusts 5 year plans.
Impact
Again there is no delay in receipt of the booking form and patients are starting treatment in appropriate timescales. We are consistently performing well against Cancer Wait Time targets and other access times recomended by the Royal College of Radiologists. Audit has shown that some patients are receiving phone calls to notify them of their appointments the same day they have seen the doctor and agreed to Radiotherapy.
The electronic forms are protected with a secure lock down that conforms to medical legislation and cannot be edited so any changes are traceable through electronic signatures.
There has been a positive impact on our clerical support workers as referral forms are no longer misplaced and resources are not wasted chasing paper booking forms across the department.
One of the key challenges was perhaps assisting the clinicians in the transition from paper to electronic systems but over time the feedback has become positive and the system is now recognised as more efficient and a risk reducer.
This new system also has also demonstrated cost efficiency savings. These are in the form of administrative costs for the 6500 plus booking forms that used to be printed and distributed each year. The electronic forms are also immediately customisable to adapt to changes in the process or treatment pathways, when this occurred with the paper based system it would take months to locate and remove the outdated versions from peripheral clinics. The changes have also helped facilitated the Trusts aim to remove the road transportation of paper based records.
