62 day performance john wayman north cumbria. 62 day performance 2012 (upper gi)

62 day performance

John WaymanNorth Cumbria

62 Day performance 2012 (Upper GI)

Upper GI Cancer pathway

Upper GI Cancer pathway

14 days14 days

Upper GI Cancer pathway

14 days14 days

Upper GI Cancer pathway

14 days14 days 14 days14 days

Upper GI Cancer pathway

14 days14 days 14 days14 days 7 days7 days

Upper GI Cancer pathway

14 days14 days 14 days14 days 7 days7 days

Upper GI Cancer pathway

14 days14 days 14 days14 days 7 days7 days

Upper GI Cancer pathway

14 days14 days 14 days14 days 7 days7 days 7 days7 days

“Further Investigations”

“Further Investigations”

<20days?

Why are we missing 62 day target?

Nationally• Long, multi-step pathway

Diminishing performance of steps:

“Step” “Pathway”1 95% 95%2 95% 90%3 95% 85%4 95% 80%

Locally• Limited capacity

– CT– USS– MRI– Bronchoscopy – Endoscopy

• Reliance on other providers– EUS– C-PEX– PET CT– EMR

Saving time

• Solutions– >95% OGD within 7 days– >95% CT within 7 days– Investigate in parallel– Provide EUS and PET in

house– Staging Admission– Remove MDT re-visits

from pathway (Investigated to Protocol)

• Risks– Capacity?

– Capacity?– Over investigation– Cost of equipment and

expertise– Capacity?– Exclude specialist

interpretation of results and insufficient CNS support to co-ordinate

Suggestions?• Agree protocols for local MDT’s for

– PET/Bone scan – EUS – Neck USS– Bronchoscopy– C-PEX

• Discuss at specialist MDT only after all investigation complete (or a result which “stops” the curative pathway)

• Combine investigations – EUS + Neck USS + C-PEX/Anaesthetic assessment

• Other Suggestion??