Emergency Radiotherapy: Streamlining the pathway from planning to treatment

Quality Improvement Poster Download

Background & Problem

Radiotherapy is an effective treatment of emergency presentations in advanced cancer, such as metastatic spinal cord compression (MSCC). NICE guidance stipulates MSCC treatment should be initiated within 24 hours of diagnosis. A delay in receiving radiotherapy may result in increased morbidity and mortality as well as adversely affecting patient experience.

Aim

Improve the emergency radiotherapy pathway from patient arrival to treatment such that all patients receive radiotherapy within 4 hours of arriving in the department.

Method

Each step of the emergency pathway was grouped into 4 stages: 1) CT planning 2) Field Mark-Up 3) Checking/Approval 4) Delivery of Treatment. An initial data collection recorded the time to complete each step and reasons for delays. Our intervention comprised of two changes to the pathway: 1) A nominated emergency radiographer of the day so that plans can be uploaded without delay 2) Request the consultant remains within the department to immediately give final approval once radiographer tasks are complete

Results

Initial data collection included 10 patients. Data on a further 10 patients was collected following the intervention. Initially 50% of patients were treated more than 4h after arriving. Following our intervention this improved to 90% (overall median time 2h 55min). Median time improved for stages 1, 2 and 3 but increased for stage 4.

Implications

This intervention has led to a reduced pathway time with notable improvement in the checking/approval stage. We learnt that communication is paramount when implementing changes that influence the work patterns of our colleagues. By presenting our initiative locally we have been able to fully engage stakeholders in the process; a key factor in facilitating changes in practice. Our future goals include maintaining the current change in practice and addressing potential delays in the final stage of the emergency radiotherapy pathway.