The Mid North Coast Cancer Institute (MNCCI) has seen consistent growth in the demand for cancer services, driven by an ageing population, increased cancer screening and prompt cancer diagnosis. The MNCCI has also seen more people surviving cancer, requiring new cancer treatment approaches and maintenance support. Delays in treatment initiation can result in adverse patient outcomes, financial burden and staff dissatisfaction. This growing demand and increasing complexity of cancer treatments is impacting service delivery at MNCCI Port Macquarie (PMQ). Oncology nursing staff face a challenging work day, due to the pressure of trying to accommodate all treatments efficiently, along with being mindful of the impact that delays in accessing treatment has on patient satisfaction.
The diagnostic phase of this project found that MNCCI PMQ treatment room service demand has increased from 6,214 occasions in 2017 to 9,13 occasions in 2022, leading to the current average treatment room occupancy for 2023 sitting at 106%. Furthermore, diagnostic processes also highlighted a high cancellation rate in cancer patients presenting for visiting medical officer consults and treatment on the same day. This poses a significant financial burden on MNCCI and cancer patients, increased environmental footprint and ineffective treatment room chair utilisation. Diagnostic geographical postcode reports revealed where patients live also impacts their treatment. 43% of our patients travel up to 172km per occasion of service to receive their treatment.
Providing care close to home
Prompt evaluation and effective utilisaton of existing human, financial and infrastructure resources is required to ensure equitable and timely access to cancer care provision at MNCCI. In alignment with the NSW Cancer Plan 2022, which promotes best patient outcomes and improved staff satisfaction, the SMARTE team seek to provide cancer care closer to patient's home. The SMARTE team has defined a number of objectives to align with their vision; prioritising areas identified as needed for change and implementing incremental changes across the project timeline. The following solutions have been identified:
- develop a defined treatment pathway and model of care (MOC)
- empower cancer patients to transition out of MNCCI
- establish a satellite clinic at Kempsey District Hospital
- improve treatment room scheduling.
Implementing solutions through collaboration
Re-defining and introducing updated treatment guidelines will educate and empower patients and carers of pre-treatment instructions alleviating unnecessary anxiety of ‘what happens next’. Developing a MOC aims to clarify roles within MNCCI, creating descriptive positions. Introducing a validated triage tool for initiation of cancer treatment will facilitate equitable access to cancer treatments that is cohesive to the current MNCCI PMQ infrastructure providing structure and pathway expectations. Engagement and collaboration with the Primary Health Care Network (PHN) to create communication pathways ensures smooth patient transition from MNCCI to PHN for ongoing disease management care. The team has created a template to communicate and documented their treatment plan, thus creating a smooth transition to chronic care management from MNCCI PMQ.
The Cancer Service Executive team are working with Hastings Council executives to create a satellite clinic within Kempsey District Hospital in early 2024. There is currently a fit for purpose unit available, which could accommodate cancer treatment closer patient's homes on country. The creation of cohesive inclusion and exclusion guidelines would include patient postcodes and risk stratification proposed drug regimens suitability for Kempsey Satellite clinic.
During the diagnostic stage a survey of treatment room staff was conducted. We found that identification of current scheduling process did not house protected breaktimes, huddle and handover times for staff and treatment spaces were overbooked with unrealistic commencement times. From this the team has implemented a colour-coded scheduling matrix titrating booking evenly across treatment spaces and protects timeframes for staff breaks, huddle and handover
View this project's poster from the Centre for Healthcare Redesign graduation December 2023.
