Alison Read, Cancer Systems Innovation Manager CCLHD Carla Kelly, (previous) Project Officer Cancer Services CCLHD

Case for change

Letter receiv (S ed from GP, 6th Ma y 2015

ourced from patient emergency

department eMR) Dear Sir/Madam

Thanks you for seeing this young man. Mr X. age 59yrs for urgent colonoscopy.

Presenting Problem Active bright blood bleeding since yesterday.

Positive occults in June 2014 – but for various reasons colonoscopy could not be

arranged. I’ve had no success trying to get someone to do a colonoscopy.

They are all away or have not got lists in GDH anymore.

In view of his current ongoing bleeding, he needs a colonoscopy on an emergency

basis. He does not have insurance. Yours Sincerely, Patient’s GP

Goal The Central Coast Local Health District (CCLHD) will work collaboratively with the Hunter New England Central Coast Primary Health Network (HNECCPHN) to ensure consistent and equitable access to public colonoscopy services for the people of the Central Coast.

Objectives 1. Reduce the colonoscopy wait times by 20% for positive faecal occult blood test (FOBT+) or high risk/symptomatic (Category A) patients by January 2016 including: • Time from GP Referral to date added to the Colonoscopy wait

list • Time from added to colonoscopy wait list to colonoscopy

procedure date (category A waitlist) 2. A 20% decrease in complaints related to colonoscopy services by April 2016.

Method Tagalongs Integrated Booking Unit –May and June 2015 Process mapping of current process – June 2015 Solutions workshop – 26th July 2015 Process mapping of new process – 20th August 2015 Steering committee meetings (n = 6) Executive Sponsor Meetings (n = 4) Project Team Meetings (n=3) Patient interviews (n=8) Patient Experience Tracking (n= 241) Procedure and wait list audits - ongoing

Diagnostics

Clinical Priority Category 1 (or A) within 30 days

High likelihood of significant organic pathology, e.g. Clinically significant overt lower gastrointestinal bleeding; active inflammatory bowel disease or diarrhoea, clinically significant iron deficiency anaemia, FOBT +ve.

*based on proportional increase

We chose A

our solutions simplified patient

to achieve: journey

Consistent and equitable access to public colonoscopy in CCLHD

Reduction in incidence & mortality from bowel cancer in CCLHD

Procedures being completed within the recommended timeframes

Planning and Implementing Solutions Currently the implementation of solutions has not occurred although the following solutions and implementation planning has been completed.

Development of a Colorectal suite of CCLHD localised pathways including: • Colorectal Cancer Symptoms • Positive Faecal Occult Blood Test (FOBT) • Screening and Surveillance Colonoscopy Top 10 Most Viewed Central Coast Pathways Feb 2016 1. Screening and Surveillance Colonoscopy 9. Colorectal Cancer Symptoms

Sustaining change

• Business case increasing capacity will support the district to manage the increased demand, which complements the direct access pathway.

• The ITC solution will allow for continual reporting and evaluation of direct access FOBT model by measuring time points such as:

• GP referral to registration

• Registration to appointment or procedure

• Procedure to discharge • GP education/consultation and localised HealthPathways

Conclusion

This project has identified the data and process changes to support the proposed increase in capacity to perform colonoscopies in CCLHD. The implementation of direct access is ongoing, however, changes in process are based on evidence (literature review), predicted increase in demand via the diagnostics phase and robust solutions identified by the project team.

Acknowledgements Executive Sponsor: Mr Matt Hanrahan (Chief Executive CCLHD)

Funding Body: Cancer Institute NSW

Steering Committee:

Andrew Roberts, Manager Division of Medicine

Debra McGillicuddy Project Officer , Cancer Services (incoming)

Glenn Hawken Gastroenterologist and Head of Department Gastroenterology

John Haydon Consumer Representative CCLHD

Karen Schofield A/Manager Division Surgery, Anaesthetics & ICU

Phil Godden General Practitioner Clinical Lead HealthPathways

Working Party:

Jenny Eisner, NUM Endoscopy Gosford

Beth Burgin, NUM IBU Gosford

Terri Pavlovich, IBU Gosford

Anna Pantoulas, Waitlist Management Clerk

Jennifer Drennan, Theatre & Waitlist Management Clerk

Lynette King, Theatre Bookings & Waitlist Management Clerk

Elizabeth Eyres, CNS Endoscopy Wyong

Lyn Frew, Waitlist Clerk

Oliver Higgins, Acting Clinical Redesign Manager

Contact

Alison Read (02) 4320 9804 alison.read@health.nsw.gov.au

Carla Kelly carla.kelly@health.nsw.gov.au

Debbie McGillicuddy debbie.mcgillicuddy@health.nsw.gov.au