Collect ME@Home

Aim

To improve patient access to the home collection service (HCS) to align with the increasing demand resulting from the Nepean cancer care centre (CCC) expansion, due for completion by December 2021.

Benefits

• Improved home collector safety within the community
• Improved efficiency of the home collection booking system
• Improved wait times for patient accessing cancer care collection room
• Increased efficiencies with home collection becoming more efficient which benefits collection room efficiencies
• Strengthened partnership between the cancer care centre and the Nepean pre-analytical department
• Improved understanding of HCS costing
• Identification, and development, of key performance indicators that will monitor HCS and its efficiencies, workflow practices and patient outcomes
• Improved community awareness of HCS and how to access this service.

Background

Currently the NSW Health Pathology Nepean Pre-Analytical Department offer a home collection service to those patients receiving treatment at the Nepean cancer care centre. This service visits patients in their homes the day prior to their chemotherapy treatment. Often, these patients choose this service because of their chronic illnesses and decreased ability to access pathology collection centres. This current community based service ensures patients have their results available as they attend their scheduled appointment at the Nepean CCC, which reduces waiting time before the start of chemotherapy treatment.

Over the next three years the Nepean CCC will undergo a capital works redevelopment with the purpose of increasing treatment capacity from the current 15 chemotherapy chairs to 30 chairs, doubling service ability to treat cancer patients. Although the current HCS model is working well and currently is able to meet patient and careers needs. It is anticipated with the redevelopment and expansion of the cancer service, that  the current HCS model will be obsolete and patients may be affected because of:

• inability to meet increased patient home collection referrals
• increased turn-around-times of results
• difficulty in access pathology collection centres (due to frailty and chronic illness)
• results not available within the hospital’s electronic medical record system (if tests are performed outside of NSWHP)
• treatment may be cancelled or postponed
• increased wait for patient prior to treatment.

Implementation

Statistical review

A review of statistics regarding the current number of collections performed by the home collector and the anticipated number of collections owing to the increase in chemotherapy chairs as a result of capital works.

This review indicated that current work practice would not provide access to the increased patient numbers. Consultation with stakeholders was conducted, which involved process mapping, patient surveys, staff surveys and solution workshops.

Stakeholder discussion

Stakeholder discussions revealed that:

• there is no standardised referral process into the  home collection service
• there is no standardise process for handling referrals
• the paper based booking system will not be fit for purpose as the service expands
• the one staff member and one car will not be able to meet the increase demand on home collections,
• the collection room in Nepean CCC will not accommodate the increase in patient capacity
• patients are very happy with the care the collection staff provide in what seems like a dysfunctional service.

Solutions testing

Solutions include:

• developing an identification criteria so those patient that require a home collection are offered the service
• creating a standardised request form handling process
• opening a collection room at Springwood Hospital (of campus) and providing a second car
• maintaining an electronic booking system for home collections.

Evaluation will be completed by July 2020.

Status

Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.

Dates

Start date: May 2019

End Date: July 2020

Implementation sites

• Nepean Cancer Care Centre
• Springwood Hospital
• NSW Health Pathology Nepean

Partnerships

• Centre for Healthcare Redesign
• NSW Health Pathology West – Nepean
• Nepean Cancer Care Centre

Evaluation

• Current paper based booking system made statistical review cumbersome.
• The implementation of an electronic booking system will support statistical review.
• The project will be considered successful when 90% of patients requiring a home collection are collected by NSW Health Pathology with collectors able to collect blood from 100% of all bookings made.
• This will decrease the amount of time clinicians spend looking for results from external providers. This will be evaluated by staff survey.

Lessons learnt

• All implementation sites must be represented on the project committee by an engaged staff member to build stakeholder engagement within their department.
• Process mapping is key to understanding what actually occurs in a department. Time spent understanding a process is invaluable. What you think happens is not what may happen.
• Deliver your message in the targets frame of reference “what’s in it for me”.
• Negative feedback is an opportunity to learn.

Contact

Maree Goodwin
A/Senior Technical Officer
NSW Health Pathology Nepean
Phone: 02 4734 3443
maree.goodwin@health.nsw.gov.au