The RCHT and NIHR PenCLAHRC pilot implementation is reducing waiting times from referral to treatment by an average of five weeks

Simulation leads to improved care pathway for bladder cancer

A new way of working has significantly reduced waiting times for thousands of people with bladder cancer in the South West, by an average of five weeks.

Each year, around 10,000 people in the UK are diagnosed each year with bladder cancer. Now, a joint simulation, study and pilot implementation between Royal Cornwall Hospitals NHS Trust (RCHT) and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR PenCLAHRC) – is reducing waiting times from referral to treatment by an average of five weeks.

The results of an analysis of three months’ of data from the pilot implementation, led by the University of Exeter Medical School, have been published in the Journal of Clinical Urology. The study showed improved referral to treatment times in both muscle-invasive and non-muscle-invasive groups of bladder cancer patients.

In 2016, the time from initial diagnosis to referral for definite treatment for patients with muscle-invasive bladder cancer was around 90 days at RCHT. An approach to NIHR PenCLAHRC saw simulation modelling designed to help RCHT identify delays in the care pathway. It also tested the impact of any potential changes to the pathway on referral to treatment time.

Using two years’ of data, the modelling team simulated the flow of patients through the system. The outcome was discussed with RCHT consultants and urologists who helped identify practical changes which could be made to reduce delays, and which could be tested in real time.

Two key changes were identified: the first was to fast-track bladder cancer patients with suspected muscle-invasion; the second was to have the specialist nurse speak to patients to discuss options while they were on the ward for Transurethal Resection of Bladder Tumour (TURBT). The model predicted that the two changes could reduce the average referral to treatment time by up to five and a half weeks.

This evidence led the Cancer Lead for Urology to immediately-re-write RCHT’s protocol for muscle-invasive bladder cancer patients – the new protocol was put in place 24 hours later.

A six-month analysis of three months’ data following implementation of the protocol has revealed significant reductions in waiting times.

There has been a 25-day reduction in the time between initial referral and TURBT for patients with suspected muscle-invasion and who are now fast-tracked. This has also resulted in a nine-day reduction across all bladder cancer patients.

A 35-day (five week) reduction in the time from initial referral to muscle-invasive patients being contacted by a specialist nurse to discuss their diagnosis and options has also been achieved. There is also an 11-day reduction across all bladder cancer patients.

The simulation and analysis were led by Dr Daniel Chalk, Senior Research Fellow in Applied Healthcare Modelling and Analysis PenCHORD, NIHR PenCLAHRC, University of Exeter Medical School. He said: “This was a fascinating project for us and one which had translated beautifully from computer simulation modelling to proven improvements in care for patients with muscle-invasive bladder cancer. By working closely with clinicians at RCHT we have come up with solutions that work for them and their patients, and which we are now looking at transferring to other urology oncology units across the South West and beyond.”

He added: “The findings from the initial simulation modelling were enough to convince the hospital to change its protocol pretty much there and then, and the results from the six month trial implementation have vindicated that decision. The sooner patients with muscle-invasive bladder cancer are treated, the greater their chances of survival and this project helps with that by reducing the referral to treatment time so significantly.”

Date: 12 October 2018