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Issues Log and Actions 14th Feb 2006

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Issues Log and Actions 14th Feb 2006 Powered By Docstoc
					Issues Log and Actions 14th Feb 2006
Corporate management The Backlog CWT Database Staff Deployment Pathway Management

Subject Corporate management of the CWT targets throughout the Trust
Issues No overall Trust policy Actions Lead Draft policy to be developed to set out Board responsibilities, Chief Exec, Hospital Directors and Cancer Lead Director Timescale

PH No detailed operational policies and Procedures to be reviewed and revised, including escalation procedures policy, navigation procedures, data flows and access levels JP Some confusion over who is responsible for To be confirmed through the Overall Trust Policy - in the delivery of the cancer waiting time meantime Hospital Directors to reaffirm responsibilities of targets - is it the SM's, Hospital Directors service managers. or the Cancer Services Director CE Lack of clarity over respective Interim arrangements to deal with backlog need to be responsibilities of navigators and service reviewed. Need to arrive at a situation where navigators managers ensure patients follow pathway to agreed timescales and service managers get involved in escalation issues. JP No performance management system Need to develop a robust performance management system throughout Trust from departments, that gives early warning of potential problems so they can be through hospital directors to CE and Board resolved. Tiered approach with detail and Deptl level and summary to Trust Board Whole exercise seen as an administrative / Review with Steve Layton & Network Lead Clinician - aim to management task - level of clinical get more ownership of the pathways, problems and solutions engagement unclear at MDT level Managers with little experience left to Review level of delegation and suitability of relevant officers implement major system reconfiguration / to carry on CWT work. working practices within Trust Strengthen training, level of supervision and define expected No exit strategy exists for sustaining the Urgent review of capacity and responsibilities within the Trust CWT agenda when the Network Team to ensure continuity of actions and data flows to sustain leave cancer waiting time performance

1st Mar 1st Mar

10th Feb

20th Feb

PH

8th Mar

PH / SL / ML

8th Mar

CE

8th Mar

CE

25th Feb

Subject Dealing with the Backlog of patients whose status on the pathway is unknown
Issues Backlog of 1154 patients with unknown status on the pathway as at 16th January Actions Lead Service Improvement team to identify status of patients and update database. Service managers to advise of status Data admin staff to be freed to commence live tracking Status reviewed on 24th Jan showed 75 confirmed cancers, 273 high risk undiagnosed, 493 low risk and 200 discharged. Cancer patients treated or expedited, diagnostic pathways brought forward - main risk is ITU capacity. Main issue is ensuring diagnostic pathway of the 273 is secure and within timeframe JP Navigation tracking form not being supplied Outpatient clinics to be targeted to deliver information. Urology mentioned from Outpatient clinics as a particular problem Peter Howie Failure to record high risk / low risk on Outpatient clinics to be targeted to deliver information. Profile to be raised tracker form means managers can't identify through presentations to clinicians. patients requiring priority attention Peter Howie Lack of essential information on CWT Merge all information onto revised CWT database ASAP See database database and inability to summarise issues log necessitates spreadsheet to be produced. Duplicate system with potential for misunderstanding. LD Unnessary paperwork being duplicated to Review the need for direct access by service managers to review patients update lists and update Peter Howie Cancer Development Team to meet with Service managers to agree format and content of reports JP / LD Timescale

24th Jan review then weekly updates until backlog fully charted 16th Feb

20th Feb to 1st Mar

14th Feb

20th Feb

Information from diagnostic departments Each diagnostic department to provide results to enable cancer team to outstanding for the high risk patients. No update backlog . Then filter and advise each service manager of the need for each service manager to approach outcome. Service managers will then chase outstanding issues. diagnostics re individual patients Notification of results to clinicians - delays until Med Secs get paper copies No definitive agreed actions from meetings with service managers - potential for different interpretations and actions not followed up Confusion caused by several lists being in existence Priorities within the backlog - at moment all patients being brought forward even if already breached Despite agreement that live tracking should commence on 16th January a backlog is still building up, particularly at Boston

DC with diagnostic managers

14th Feb 1st Mar

System to be developed to alert Med Secs of results, or ensure Med Secs trawl Path (&? Other) databases regularly for their patients results Peter Howie Agreed summary action list with timescales to be circulated within 1 hour of meeting finishing DC Lists to be co-ordinated through one contact point (DC) and agree in advance what lists are needed by service managers each week DC Decision needed on policy regarding patients who have already breached Peter Howie/ PH / DC Reaffirm decision that service managers concentrate on backlog, leaving trackers to start live navigation. Establish size of this and combine to get total picture of unknown patients Clarify status of all patients on the CWT database - see doc "Lincs Peter Howie backlog status 13th Feb 06" - total of 1743 patients now on database Aim to do todays patients today from 20th Feb (requires review of workloads) JP / LD Reports to be developed identifying capacity requirements as part of database review - see Database issues log Reports to be produced by speciality by 16th Feb LD

15th Feb 10th Feb

16th Feb

16th Feb

20th Feb

Information from CWT not able to be interrogated inteligently to focus on key priorities for service managers

16th Feb

Subject There needs to be one robust database which can be kept up to date and can produce meaningful reports for action
Issues There are some vital fields missing from the database such as "Decision to treat," "Planned treatment Date," and "Actual treatment date" Actions CWT database to be refined to include these fields and all fields on cancer dataset. Lead Timescale

LD The database does not allow for intelligent Database to be redesigned and access to enquiry / report interrogation and only produces writing to be given to designated database lead. predetermined reports In view of deficiencies of CWT database a separate spreadsheet has had to be developed to summarise patient details and update with service managers. This can lead to duplication and confusion In interim one designated person (Julie Pipes) to control master copies and ensue consistency between databases As soon as possible, after CWT revised, consolidate all information into one database.

13th Feb

LD JP

13th Feb 9th Feb

LD

14th Feb

Reports for service managers not available Daily reports to be produced specific to service managers to enable them to highlight particular highlighting patients who are reaching the predetermined service issues in their departments, pathway time standards. (24 days to diagnosis, 31 days to potential breaches or need for expediting or MDT, 48 days to treatment date arranged). Traffic light escalation system to aid identification of priorities for action. Database requires searching through diagnostic databases and manual entry Pathology reports detail all patients which is a huge list to be searched through Return of tracker forms sporadic and inaccurate.Requires manual entry. Review scope for obtaining information directly and electronically for downloading into system from pathology, radiology and endoscopy services

LD

20th Feb

LD with IT Pathlinks to be requested to provide dailiy extracts of cancer patient results to Cancer Development Office LD Review operation of tracker form and potential for greater integration between 2ww office and data admin team. JP

16th Feb 16th Feb 8th Mar

Currently OP will have to fill in a tracker form and request diagnostic tests. These will then be booked by the diagnostic dept but the trackers will then approach to see if the date is OK. Potential over administration Uploads onto CWT database from PAS taking up to 8 days from receipt of GP referral

Review getting diagnostic appt date "right first time" then advising trackers via electronic download.

JP Review where delay is occuring - from 2ww office to PAS or PAS to CWT database JP

1st Mar

17th Feb

Subject Need to ensure the deployment of staff optimally to undertake the required work to agreed standards
Issues No extra staff taken on for navigation, unlike other trusts who have created the role. Other Trusts in Mid Trent utilised Service Improvement Fund Actions Review level of staff required to address workload and to maintain todays work today. Consider redirecting SI Fund from equipment to fund staff either as short term measure or longerterm as necesary Lead Timescale

LD PH LD 20th Feb

Navigation given to data admin people, Review deployment of data admin and MDT staff whose skills and motivations are not necessarily those required for navigation. MDT co-ordinators and data admin staff not Review deployment of data admin and MDT staff integrated and both small unviable teams at each hospital site Training and supervision of staff not Service Improvement staff to work alongside data admin staff sufficient to enable them to carry out new to improve skills and explain role roles In longer term consider training and induction Management and supervision of the Cancer Review level of skills required for roles and consider Development Team reliant on junior reorganising responsibilities within Dept managers with insufficient knowledge and expertise Department susceptible to risk when Develop contingency plans with delegated responsibilities managers go off sick or on Annual leave - (either upwards or downwards) for providing essential cover, knowledge resides in individual officers In absence of Cancer Development Second Linda Donohoe to take charge of the department Manager and Data & Audit Co-ordinator the with immediate effect as a temporary measure. Dept essentially ceased to function Responsibilities as set out in attached document

1st Mar

LD

1st Mar

JP

23rd Jan

DC

10th Mar

DC

10th Mar

PH

13th Feb

Subject Active management of the patient pathway, through prospective tracking needs to be embedded into the Trust
Issues Tertiary referrals being lost to system Actions All tertiary referrals to be co-ordinated through Cancer Development Office with a designated tracker to liaise with supernavigator at Nottingham re progress Individual tumour sites to develop internal tailored pathways and timescales against which patients will be tracked JP / SL / MDTs Trust to develop a contingency plan to provide sufficient capacity for planned cancer work. Peter Howie Depends on accurate forecasting of overall ITU requirements from CWT database LD / JP Trust to adopt Nottingham "clearing system" whereby cons radiologist channels patients to first available appropriate DC slot. Trust to be made aware of system and discuss local communication arrangements with Nottingham PH Short term exercise to deal with the peak in activity necessary to clear the backlog Inlonger term need to ensure sufficient capacity on an ongoing basis to deal with average weekly presentations, alowing for peaks and troughs Both dependant on CWT database reports being turned into LD Review extent of problem and implement affordable solutions. Straight to test is more efficient and should EBD / Peter therefore save money. Howie Reports from revised database to be considered by Service Managers. EBD / Peter Agreement with Service Improvement Lead on areas for Howie 20th Mar Lead Timescale

LD

17th Feb

All pathway management is against generic timescales and does not reflect the complexity of patient pathways ITU capacity not sufficient to deal with patients requiring level 2 or level 3 care

17th Feb

PET scanning delays in using Mt Vernon

15th Feb

There is a lack of prospective capacity management to ensure sufficient diagnostic and treatment slots are available to treat patients coming through the 2 week wait route. Straight to Test arrangements agreed for Urology and Colorectal not implemented due to financial and capacity constraints Delays and bottlenecks found through prospective tracking not yet recorded and actioned

20th Feb

20th Feb

1st Mar


				
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Description: Issues Log and Actions 14th Feb 2006