Adapting one-stop breast cancer diagnostic clinics to transform pleural disease service

CW Innovation Fellow: Dr Ryan Dhunnookchand

Role: Consultant in Respiratory
Organisation: Chelsea and Westminster Hospital NHS Foundation Trust and West Middlesex University Hospital NHS Trust

Rapid Access Pleural Intervention & Diagnostics Service (RAPID)

Summary: Redesign service for patients with lung diseases, including collapsed lung; fluid accumulation around the lungs; or cancer surrounding the lung known as mesothelioma. The outpatient or day-case service includes one-stop assessment; diagnostic intervention; and management of pleural disease.

Story of the project

We have created a safe, calm environment adjacent to our Respiratory Ward, called Syon 2. It is designed and works as an outpatient or day-case service, providing dedicated expert care for patients with pleural disease. There are two dedicated Rapid Access Pleural Intervention & Diagnostics Service (RAPID) clinics per week. Most patients attend with a scheduled appointment and return home usually within two hours.

The redesigned pleural service is modelled on the national breast one-stop clinics, which aim to support the early diagnosis of breast cancer. RAPID draws on several key elements that have contributed to the success of the one-stop model, and adapts them to the diagnosis and management of pleural disease. These include:

• One-stop pleural clinics: within the two hour appointment patients receive thoracic ultrasound, CT imaging and pleural procedures. This enables real-time diagnosis, treatment decision-making, referrals and support patients to understand their condition and treatment options.
• Integrated multidisciplinary team: brings together expertise and decision-making from respiratory physicians, radiologists, pleural nurses and thoracic surgeons.
• Accelerated pathway (RAPID): compressed diagnosis timeline, mirroring Faster Diagnosis Standard targets for breast cancer.
• Dedicated pleural radiology and pathology support: radiologists with pleural expertise review imaging, with fast-tracking for pleural samples.
• Patient-focused and efficient: offers coordinated care for oncology patients, reducing wait times and repeat attendances.

Outcomes

RAPID has transformed the pleural cancer pathway at West Middlesex University Hospital NHS Trust from fragmented to efficient and person-centred:

• Diagnosis speed: patients are referred from General Practice (GP) and community services, though most referrals are made my Emergency Department, Acute Medicine and other Hospital Medical teams using a dedicated referral system. Timeline is compressed to under seven days, supporting patients to access treatment quicker than previous pathways.
• Patient experience: reduced waiting times and repeat attendance.
• Clinical outcomes: patients suspected pleural malignancy are prioritised.

Advancing the project through CW Innovation Fellowship collaboration

Digital healthcare innovation is best achieved by networking – seeing what colleagues, business partners and third-party stakeholders have on offer. CW Innovation and DigitalHealth.London have brought together the best of the best for the Fellowship, including professional coaching, one-to-one advice from industry leaders, speakers with clinical excellence, digital pioneers and in-house entrepreneurs. I look forward to joining the alumni network.

The Fellowship in its purest form gives front-line clinicians the space, expertise and resources to aim higher and innovate better.

RAPID has moved from strength to strength with each learning day, and you can count on all the resources from the Fellowship to bring your innovation to the front-line. My team are already working towards patient goal.

My skills, innovation and determination to improve patient care and efficiency has created three further innovative solutions, which I am excited to realise and deliver.

Next steps

We anticipate that the project will become self-sustaining once full integrated into Cerner EPR. This integration is as a response from patient feedback, which highlighted the need for immediately accessible, relevant information in a printable format. This includes automated letters and clinic appointments, as well as providing relevant information with the first appointment letter.

Whilst our service is designed around the West Middlesex University Hospital NHS Trust patient experience and hospital resources, the model could be implemented in other hospitals looking to develop their Thoracic Pleural Service.

For more information on the CW Innovation Fellowship, which has been rebranded from the Horizon Fellowship, visit the CW+ website. You can also check out our Innovation Directory to browse through the full list of Fellows.