References
Service improvement in a nurse-led clinic for extracorporeal photopheresis
Abstract
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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