Alfred A, Taylor PC, Dignan F The role of extracorporeal photopheresis in the management of cutaneous T-cell lymphoma, graft versus-host disease and organ transplant rejection: a consensus statement update from the UK Photopheresis Society. Br J Haematol. 2017; 177:(2)287-310

Bisaccia E, Vonderheid EC, Geskin L. Safety of a new, single, integrated, closed photopheresis system in patients with cutaneous T-cell lymphoma. Br J Dermatol. 2009; 161:(1)167-169

Burgess N. A lean presence. Lean Management Journal. 2011; 26-29

Edelson RL. Mechanistic insights into extracorporeal photochemotherapy: efficient induction of monocyte-to-dendritic cell maturation. Transfus Apher Sci. 2014; 50:(3)322-329

Gilson D, Whittaker SJ, Child FJ British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous lymphomas 2018. Br J Dermatol. 2019; 180:(3)496-526

Klassen J. The role of photopheresis in the treatment of graft-versus-host disease. Curr Oncol. 2010; 17:(2)55-58

Knobler R, Arenberger P, Arun A European Dermatology Forum: Updated guidelines on the use of extracorporeal photopheresis 2020—part 1. J Eur Acad Dermatol Venereol. 2020; 34:(12)2693-2716

Knobler R, Arenberger P, Arun A European Dermatology Forum: Updated guidelines on the use of extracorporeal photopheresis 2020—part 2. J Eur Acad Dermatol Venereol. 2021; 35:(1)27-49

Lean Enterprise Institute. A brief history of lean. 2021. (accessed 15 September 2021)

Mazzocato P, Stenfors-Hayes T, von Thiele Schwarz U, Hasson H, Nyström ME. Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement. BMJ Open. 2016; 6:(7)

Pierelli L, Perseghin P, Marchetti M Extracorporeal photopheresis for the treatment of acute and chronic graft-versus-host disease in adults and children: best practice recommendations from an Italian Society of Hemapheresis and Cell Manipulation (SIdEM) and Italian Group for Bone Marrow Transplantation (GITMO) consensus process. Transfusion. 2013; 53:(10)2340-2352

ProcEx Solutions Ltd. The ProcEx model for Lean Implementation. 2021. (accessed 15 September 2021)

Rushton C, Robertson L, Taylor T, Taylor P, Button P, Alfred A. Improving the service for patients receiving extracorporeal photopheresis using Lean principles. Br J Nurs. 2016; 25:(16)917-921

Scarisbrick JJ, Taylor P, Holtick U U.K. consensus statement on the use of extracorporeal photopheresis for treatment of cutaneous T-cell lymphoma and chronic graft-versus-host disease. Br J Dermatol. 2008; 158:(4)659-678

Willemze R, Hodak E, Zinzani PL, Specht L, Ladetto M. Primary cutaneous lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol. 2013; 24:vi149-vi154

Worel N, Leitner G. Clinical results of extracorporeal photopheresis. Transfus Med Hemother. 2012; 39:(4)254-262

Service improvement in a nurse-led clinic for extracorporeal photopheresis

23 September 2021
Volume 30 · Issue 17


The skin tumour unit at one London hospital has been providing extracorporeal photopheresis (ECP) treatment since 2012, using an online fully integrated system. This report summarises 9 years of continuous process improvement, which has enabled the team to meet the growing demand for ECP treatments for cutaneous T-cell lymphoma (CTCL) and graft-versus-host disease (GvHD) patients. The unit formed a partnership with a lean-management company to go through the process of evaluation of capacity constraints, design layout and patient scheduling. Methods: Increased capacity year-on-year and over the 9-year period was calculated based on data collected from records. The authors reviewed the nurse staffing resources allocated for ECP treatments over the same period, and financial value created by the continuous improvement (additional number of treatments multiplied by the national tariff for ECP treatments). Results: In 2012 the average number of ECP treatments per nurse per week was 11. With the implementation of the new planning tool, and improved working practices, the average number of treatments per nurse per week has more than doubled to 23. Nurse staffing was maintained at 4 nurses per shift to deliver ECP treatments. The unit recorded additional revenue of approximately £3.2 million in 2020 compared with 2012. Conclusions: The team has successfully increased the capacity of the service to deliver treatments without incurring any additional nursing costs, resulting in more patients with CTCL and GvHD being able to access ECP treatment and a cost benefit for the Trust. The service continues in its mission to grow and provide a superior patient experience.

Ensuring effective and efficient use of healthcare resources is a system-wide priority. The Guy's and St Thomas' NHS Foundation Trust skin tumour unit, based at Guy's Hospital in London, has been providing extracorporeal photopheresis (ECP) since 2012, using a fully integrated online system. Demand for ECP procedures has continued to increase year on year and the department sought to assess and address the increasing demand for ECP procedures while also maintaining the same number of nurses within the unit. This article summarises the department's 9-year journey of continuous process improvement, which has enabled it to meet the growing demand for ECP treatments for patients with both cutaneous T-cell lymphoma (CTCL) and graft versus host disease (GvHD).

The department formed a partnership with a lean-management company, ProcEx Solutions Ltd, to lead the team through the evaluation of capacity constraints, design layout and patient scheduling using the Kaizen concept (Mazzocato et al, 2016). In 2020 the unit faced challenges as a result of the restrictions imposed due to the COVID-19 pandemic, which would mean that the team would potentially be restricted in the number of patients they would be able to treat. Going without regular ECP treatments could have a devastating effect on patients, and the unit needed to ensure it could continue to provide the service to as many patients as possible but still work within the increased safety restrictions. Using the ProcEx tools, the team were able to minimise the number of reduced treatments, with a reduction of only 6% compared with 2019.

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