Helping the NHS make informed decisions

Beating Bladder Cancer

The Problem

It can often be hard to spot elements that make a system inefficient, and healthcare pathways that have grown responsively can be difficult to unravel. In 2016 the Royal Cornwall Hospitals Trust identified possible improvements to their bladder cancer pathway, but lacked the skills to explore these changes without a trial-and-error approach. The aim was to bring the average time patients wait to be referred for definitive treatment down from its 90-day average.

The Solution

PenCHORD used two years’ worth of data to create detail process map and then were able to simulate the flow of patients through the system. They worked with consultants and urologists to identify practical changes that might reduce delays, and tested their impacts using the model. With two key reconfigurations made at no additional cost, the simulation predicted that the average wait time for treatment could be reduced by several weeks. The evidence was so compelling that the department swiftly re-wrote their bladder cancer patient protocol, implementing it just 24 hours later.

The Value

Six months following the implementation of the changes, data analysis revealed that significant reductions in waiting times had been possible, shortening waiting times by 35 days in some cases. With 10,000 or so people in the UK diagnosed each year with bladder cancer, the team is hoping its success will be replicated in other trusts across the country.

Full article available in Impact Magazine, Spring 2018: ‘PENCHORD: Helping the NHS make informed decisions with Operational Research’ pp22-25

Treating Stroke Patients

The Problem

Time is one of the most important factors when treating stroke patients and, in some cases, administering clot-busting medication can limit brain damage and reduce the likelihood of disability, yet working out whether or not a patient is suitable to receive particular treatment types can be complicated and time-consuming.

The Solution

The Peninsula Collaboration for Health Operational Research and Development (PenCHORD) has been working with the NHS to create a detailed working model of the path that patients take when they have a stroke, replicating the journey from onset of the condition right through to the point of treatment.

They include the roles of paramedics, nurses, emergency department clinicians, the acute stroke team and the radiology department, and then use this model to test how changes in the system might affect the delivery of care. With several new initiatives established, the team implemented their findings at the Royal Devon & Exeter Hospital Trust.

The Value

Within 18 months of implementation, the number of patients with acute ischemic stroke receiving medication more than doubled, increasing from 4.7% to 11.5%. The average time patients had to wait for this treatment also dropped substantially, coming down from 58 minutes to 33.

Four years into the new processes, treatment rates have increased threefold, up to 14%. For over 600 people admitted with acute stroke every year, the Royal Devon & Exeter Hospital is matching or beating the performance of the big urban stroke centres elsewhere in the UK and the world.