MDT Lead Clinician
Self Assessment
Key Themes
Structure and function of the service
The MDT has a clear structure and operational policy. All core and extended team members arein place with adequate attendance at the MDT. The only issue is that there is no cover for theradiology core team member.
The service now has the benefit of 2 specialist nurses which has helped to ensure that manymore patients have access to their expertise and support.
Waiting times targets for 14, 31 and 62 days have been adhered to by the Lung MDT andachieved for the reporting year 2010/11.
In the reporting year 2010, we have seen 132 patients. (See Hard Copy evidence).
There is a yearly operational meeting where outcomes are discussed and feedback given onpatient experience, capacity and demand, investigation and treatment protocols, researchissues and audit. The work programme is reviewed annually.
Coordination of care/patient pathways
Although we have to adhere to a limited timeframe we try to offer patients a convenientappointment for clinic and investigations. We always see patients within 2 weeks of referral andin most cases a CT scan is done before the first OPA. We are at present reviewing the pathwayand have plans to introduce a one stop clinic where CT-guided biopsy or bronchoscopy can becarried out on the same day if appropriate.
There are clear guidelines for MDT referral and for how information is communicated to patients SELF ASSESSMENT REPORT for Burton Hospital - Lung MDT (published: 18th August 2011) and other health professionals both within the MDT and outside of the meeting. The MDT meets The appointment of a 2nd Clinical Nurse specialist will enable more patients to be supportedthrough the diagnostic pathway.
Detailed Network guidelines are in place which members of the MDT have had input indeveloping. We take part in any relevant network audit.
Patient experience
Feedback from the National Patient Survey and also the Improving Lung Cancer OutcomesProject (ILCOP) have been discussed by the Lung MDT.
What was done well (Patient Comments)- Care received by the doctors and nurses was the best.
- Impressed by the follow up monitoring and reassurance.
- Everyone has done everything to help me cope with my illness.
What was not done so well- Waiting times for treatment very long.
- Answerphone messages not picked up when nurse on courses and holidays or sick.
- One patient said they received too much information and one patient said they did not haveenough.
Action Plan- Lung CNS'S working with oncology staff to look at improving pathway for chemotherapypatients.
- CNS's looking at Information Prescriptions which will be implemented in next phase.
- Appointment of 2nd CNS will ensure nurse cover.
The Fatigue Anxiety and Breathlessness Courses (FAB) continue to be evaluated.
Lung Nurses are working to improve the Holistic Needs Assessment for patients by reviewingthe documentation and the best way to move this forward. This will be in discussion withpatients. They are also engaging with the developing acute oncology service as is the rest ofthe Lung MDT.
We all strive to improve patient experience and listen continuously to their concerns.
Clinical outcomes/indicators
Number of cases: 132Anti-cancer treatment 95 (72%)Histological confirmation 105 (79.5%)Discussed at MDT 131 (99.2%)Surgical resection (overall) 31 (23.5%)Death within 1 month of surgery 3 (2.3%) SELF ASSESSMENT REPORT for Burton Hospital - Lung MDT (published: 18th August 2011) Lung Clinical trials at Burton (also see Hard Copy evidence).
- ETERCC1 Targeted Trial. A multicentre, randomised, phase III trial of platinum-basedchemotherapy versus non-platinum chemotherapy, after ERCC1 stratification, in patients withadvanced/metastatic non-small cell lung cancerStatus: Open for recruitment at BHFT (1 patient to date) - FRAGMATICA randomised phase III clinical trial investigating the effect of FRAGMin Added to standardTherapy In patients with lung Cancer.
Status: Open for recruitment at BHFT (14 patients to date) - LUNGSTARA multicentre phase III randomised double blind placebo, controlled trial of pravastatin added tofirst-line standard chemotherapy in patients with small cell lung cancer.
Status: Open at BHFT (8 patients to date) - MALCSA population based case-control study of mesothelioma and lung cancer in relation tooccupation among British men and women under the age of 60Status: Open at BHFT (20 patients to date) - MEDLUNGCritical evaluation of protein and DNA biomarker detection for early detection of lung cancerStatus: Open for recruitment at BHFT (2 patients to date) - MesoVATSProspective randomised controlled trial of video-assisted thoracosopic (VATS) cytoreductivepleurectomy compared to talc pleurodesis in patients with suspected or proven malignantmesothelioma.
Status: Open for recruitment at BHFT (6 patients to date) - SMOKING IN LUNG CANCERDoes smoking status after a diagnosis of lung cancer affect outcomes-Status: Open for recruitment at BHFT (5 patients to date) National Targets:10% into all lung trials (equivalent to 10 patients to recruit from April 2011 to March 2012)7.5% into randomised controlled lung trials (equivalent to 8 patients to recruit from April 2011 toMarch 2012) Actual recruitment from April 2010 to March 2011:15 patients into all lung trials11 patients into randomised controlled trials Actual recruitment from April 2011 to 14th July 2011:9 patients into all lung trials4 patients into randomised controlled trials The Lung CNS has audited the workload of the Clinical nurse specialist using levels of SELF ASSESSMENT REPORT for Burton Hospital - Lung MDT (published: 18th August 2011) intervention adapted from the Macmillan levels of intervention. This is an ongoing audit processcompleted monthly and together with the LUCADA data was used successfully to gain fundingfor 2nd CNS.
Good Practice
Good Practice/Significant Achievements
Improved resection rates and histological confirmation rates.
All key outcome measures well above national averages.
Introduced new Infoflex patient management system into MDTs.
Improved the patient pathway by embedding "straight to CT" service and beginning earlier useof PET-CT to streamline the pathway.
Plans to introduce a one-stop clinic for clinic + biopsy/bronchoscopy.
Participation in ILCOP project.
Close liaison with allied health professionals (Macmillan OT, Physio and Dietician) to enableprompt response to patient holistic needs assessments.
Immediate Risks
Serious Concerns
General Comments
Organisational Statement
I, Dr Paul Beckett (Lead Clinician) on behalf of BURTON HOSPITALS agree this is an honest and accurate assessment of the Lung MDT.
SELF ASSESSMENT REPORT for Burton Hospital - Lung MDT (published: 18th August 2011)

Source: http://www.cquins.nhs.uk/reports/SA-rpt_Burton_Hos_Lung_MDT_110818-1354.pdf


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