Aim: This project aimed to align the timelines from initial receipt of referral to a regional health service to first treatment for oesophago-gastric (OG) cancer patients with the optimal timeframe of 42 days recommended in the Optimal Care Pathway (https://www.cancervic.org.au/downloads/health-professionals/optimal-care-pathways/Optimal_care_pathway_for_people_with_oesophagogastric_cancer.pdf).
Method: The redesign methods of define, measure, analyse, improve and control (DMAIC) were used. Initial data collection defined the baseline problem. Tools such as process mapping with value stream mapping and cycle times, ‘5 whys’, fishbone diagrams, ‘voice of the customer’ interviews, rapid improvement events and prioritisation charts were incorporated. The decision was made to focus on the timeline from receipt of referral to diagnosis of OG cancer. Further measurement and analysis utilising multiple health service databases was completed.
Results:
A major process change was implemented within specialist clinics and patient services. Post-implementation data collection showed that the median time from receipt of referral to diagnostic procedure was reduced by five days for direct access endoscopy referrals. Approximately 85% of direct access endoscopy referrals were processed using the faster method. Up to 2,000 endoscopy patients may be impacted annually. An estimated 133 hours of ward clerk or nurse time and nearly $4,000 will be saved annually. Other impacts included the implementation of more easily-understood English forms for patients, template development for general practitioner communication and initialising a pilot for improved return of patient medical questionnaires. Changes were documented in new flowcharts and orientation information. Interviews with staff showed that the changes were well accepted. Initial data showed a 17% absolute improvement in alignment with the OCP timeframe from receipt of referral to first diagnosis.
Conclusion:
The redesign method was successfully utilised to improve diagnosis timelines for OG cancer patients in a regional health service.