RESUMEN
For the duration of COVID-19, cancer pathways will be affected by the significant loss of elective capacity and increased risk of COVID-19-related morbidity and mortality for cancer patients. Imperial College Healthcare NHS Trust (ICHT) has developed a simple, effective MDT recording process, using keywords, to support the tracking of patients who require treatment prioritisation, repeated clinical/MDT reviews and/or need adjustments to their treatment. Following implementation in April, the percentage of MDT outcomes with keywords recorded was 79% in June and 77% for the first two weeks of July. Analysis of the 3,680 MDT outcomes with at least one key word recorded showed that 96% had the 'intention to proceed' recorded. For 59% patients, the decision was to 'proceed', 5% patients are being monitored, 3% patients have been deferred and 29% were 'closed'. While this process adds time to busy MDTs, we hypothesise that it will support the tracking and safety-netting of thousands of cancer patients whose care has been affected by the pandemic. The process could easily be implemented in other trusts and adapted for other specialties.
RESUMEN
COVID-19 has highlighted the need for a standardised approach for prioritising patients requiring elective care. The Royal College of Surgeons of England (RCS) developed guidance at the start of the pandemic for prioritising surgical patients based on the urgency of different procedures. Imperial College Healthcare NHS Trust (ICHT) has extended this to all aspects of elective care to enable standardised decision-making based on clinical priority, clinical harm and patient vulnerability. This was a clinically led project that involved close collaboration with lay partners, who were concerned that the RCS guidance lacked the sensitivity to reflect individual patients' needs. Our novel elective care recovery matrix is designed to be applicable across all elective care services and at Trust or system level. Implementation at ICHT progressed rapidly: as of 28 August 2020 >200 consultants have received training on the process and 58% of all surgical orders have been prioritised using the new framework (5,134/8,800). While COVID-19 was the driver, the applicability can be wider and could inform new ways of working. The framework enables rapid quantification of individual patient care requirements, thus enabling clinicians to target more accurately those patients with the greatest need and those who would see the greatest benefit.
RESUMEN
The oncology department at Imperial College Healthcare Trust ranked last in the National Cancer Patient Experience Survey in 2011/12 and 2012/13. Length of stay (LOS) was above national average. General Medical Council surveys of junior doctors highlighted significant issues with lack of senior review, education and working hours. Inpatient surveys echoed this with poor patient experience, and major complaints exposed lack of joint nursing and medical care. Restructuring the inpatient care pathway began in 2012 and centred around four target areas: 1) introduction of a ward based consultant; 2) defined admission criteria; 3) development of a cancer assessment unit; and 4) designated elective beds. Restructuring had a rapid effect on the service: total admissions per month declined from 246 in March 2013 to 183 in May 2014 and median LOS fell from 4.3 to 2 days over the same period (p<0.001). Complaints and serious incidents also fell and junior doctor satisfaction improved.
RESUMEN
This paper argues that establishment of a positive culture that promotes and enhances levels of medical engagement should be a key objective of medical leadership. Two particular and critical arguments underlie this proposition a) that levels of medical engagement, as measured by the Medical Engagement Scale, is strongly associated with organisational performance, including quality of care; and b) that any aspiration to achieve an organisational culture known as 'clinically led' cannot be achieved without high levels of medical engagement. Medical engagement as a concept is discussed, as well as the need for robust and reliable assessment. Approaches to support organisations enhance levels of engagement are presented as part of the goal to improve overall care quality.