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Stahmis. Started Jan 2009 Commissioned at open tender against five other bids. Clinical responsibility and comitment to excellence Consultant led Well-respected.

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Presentation on theme: "Stahmis. Started Jan 2009 Commissioned at open tender against five other bids. Clinical responsibility and comitment to excellence Consultant led Well-respected."— Presentation transcript:

1 Stahmis

2 Started Jan 2009 Commissioned at open tender against five other bids. Clinical responsibility and comitment to excellence Consultant led Well-respected Efficient Safe Intense loyalty, commitment and pride in the service and its achievements by LOCAL consultants and staff. Stahmis recognises the need for Demand Management and firm triage and has developed new software to face this challenge.

3 Stahmis : Has uncovered an un-met ultrasound need from local GPs Has now reached a steady state activity Is extremely well received by: – Patients – And GPs Is identifying and treating conditions early Is saving money by apropriate referral Is saving money by early referral

4 GP questionnaire: 59 Local GPs responded to our detailed questionnaire. GP verbal feedback Unrequested letters Patient Satisfaction report Stahmis scan rate: – 43 scans / 1000 patients East of England guidance for Beds and Herts suggesting: – 120 scans /1000 patients (inc Obstetric and acute sector) USA US scan rate article: – 136 scans /1000 patients (in Obstetric and acute sector) iRadiology new triage Software Stahmis activity Year on Year showing static or decreasing activity Graph of referrals against Watcom, East of England and USA guidance.

5 Patient Satisfaction 100% of patients surveyed rated their overall experience as good, very good or excellent. 100% of patients surveyed waited less than 20 minutes for their scan 88% of patients were seen within 2 weeks (Some patients were on holiday, or requested a later appointment)

6 Patient Survey (2)

7 GP satisfaction It would be a tragedy to return to the ‘old’ system Absolutely fantastic and valued service and is cornerstone of modern medical care This prompt diagnosis via scan saved an inappropriate RAU admission The previous WHHT U/S service was frankly appalling. I’ve been a GP here for 12 years and I always saw the slow to scan and slow to report U/S service at WHHT as a dismal facility. To compare STAHMIS against Watcom is ludicrous. Brilliant service. Has made a big difference to care and reduced the number of consultant referrals I am certain that availability of U/S at short notice has prevented acute admission to hospital. STAHMIS is the best example of how diagnostics can empower GPs to manage patients better

8 GP satisfaction Absolutely fantastic and valued service and is cornerstone of modern medical care to have rapid access to diagnosis. I would refer many more patients to A&E and acute admissions if rapid access scanning were not available to quickly rule out serious complications.

9 GP satisfaction This prompt diagnosis via scan saved an inappropriate RAU admission and allowed me to promptly direct him to the appropriate consultant. An invaluable service. Thank you.

10 GP satisfaction With all due respect to our consultant Public Health colleagues and PCT Managers – the previous WHHT uss service was frankly appalling. I’ve been a GP here for 12 years and I always saw the slow to scan and slow to report uss service at WHHT as a dismal facility. To compare STAHMIS against Watcom is ludicrous. The implication is that the PCT AND Public Health doctors are pushing for us to level down to a shoddy, poor, second-rate service. The PCT/PH team ought to be placing their energies into contract enforcement at Watcom and enthusing the Watcom PBC and GP Shadow Commissioning Consortium to commission a better uss service in their locality. Please pass on these comments verbatim to the PCT and PB doctors.

11 A well-organised, timely, excellent service. Has made a huge impact on my clinical care (especially gynae and to a lesser extent musculoskeletal). ALL referrals will require discipline and agreed criteria. Ultrasound is no different. If we want to keep STAHMIS (which I do), costs must be reduced. Ultrasound delay will lead to OPD referrals going up. If we cant work cases up adequately more inappropriate referrals will be made. Brilliant service. Has made a big difference to care and reduced the number of consultant referrals as aiding ability to manage patients in general practice. I am certain that availability of uss at short notice has prevented acute admission to hospital. Anxiety about undiagnosed conditions has markedly reduced. The service is far better now – don’t sabotage this improvement for patients. STAHMIS is the best example of how diagnostic can empower GPs to manage patients better Excellent service, so like all good things of late in the NHS, get rid of it!! Please do not close this service. It’s a wonderful service now and excellent quick results (it is dreadful that we have to wait 2-3 for the results of x-ray reports – as if GPs are second class citizens!). I am sure this service helps to reduce the wait for possible cancer patients. Unfortunately you are a victim of your own success! Perhaps you need some protocols – good luck Excellent service. Helps to point patient in correct direction for treatment or stops referral being necessary. Agree that some triage is appropriate It is a very good diagnostic service and has saved me referring otherwise to secondary care, which I would do if the wait for ultrasound is longer.

12 Letter from Dr Bruce Covell listing early nephroma, early colnic cancer and early lymphoma detected

13 Unsolicited letter from Dr Rachel Pay: Dr KL Ng detects early bowel cancer allowing early curative colectomy. Dr Julian Godlee The Maltings Surgery 8-10 Victoria St St Albans Dear Julian Here is an example of how timely ultrasound by a consultant has dramatically altered the course of a patient’s treatment. I saw a 58 year old lady with a 2-3month history of R sided abdominal pain. I decided to investigate with blood tests and ultrasound. 11 days after her first appointment with me, the Consultant Radiologist Dr Ng picked up a localized thickening of the bowel wall with minor pericolic fluid and suggested urgent onward referral as malignancy could not be excluded. She was then referred by 2 week wait system. She was diagnosed with a moderately differentiated adenocarcinoma following a colonoscopy and subsequently had curative R hemicolectomy. I think the diagnosis would have taken much longer and been considerably harder to reach without this early scan by a consultant. She had no weight loss, no change in bowel habit, no rectal bleeding and her blood tests were all normal. Ultrasound is well known to be operator dependant and I suspect that another less qualified operator may not have picked up such a subtle change. This is not the first cancer I have picked up early using StAHMIS scans. I can think of at least 3 in the last year 6-9 months including a renal cell carcinoma, a sarcoma and this one. Regards Dr Rachel Pay

14 Activity (SACH)

15 Activity Stahmis

16 Activity Levels Activity has levelled out and is now steady averaging 500 scans per month at a rate of 43 scans per 1000 patients. The historically poor service masked a previously unmet need. (Increased publicity about ovarian cancer screening may drive up demand.)

17 Guidance on ultrasound scans per head of population Recommended scan activity by Eof E Strategic Health Authority paper for Beds & Herts 2006 = 120 per 1000 population (inc Obs & acute) Stahmis activity (for a population of 140,000) = 43 scans per 1000 population Watcom = 22.5 scans per 1000 population (see later assessment of Watcom service)

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19 Comparison to Watcom Dr Tom Novak, GP Callowland ‘Watcom currently has a 2-4 week wait, and additional days for report. Not anything like you have in St Albans Infinitely inferior service – no doubt whatsoever Watcom would jump at having your service Any planned change for Stahmis is basically a reduction in quality’

20 Dr Raj Bhamra, Fernville ‘2-4 week wait, with a further 10 days for the report Scans by sonographers Not very good service, to be honest’

21 Correction of PCT statements PCT say: Cost of ultrasound is included in out patient tariff, and therefore scan prior to referral results in additional costs being incurred. Stahmis feel this state of affairs should be changed, and a reduced tariff paid when the GP has appropriately investigated the patient. PCT graph seems to show inexorable rise in scan frequency Stahmis say that the un-met need is now clear, and the demand for scans has levelled off at an average of 500 scans per month.

22 PCT say Stahmis is not linked to PACS. Stahmis will be investing in expensive PACS software once the future contract is secured. Scans will be linked via CIMAR and linked to PACS in WHCT.

23 PCT say : There is no evidence of reduced referral. Stahmis challenge this, as do the vast majority of our GP respondents. It is universally felt that early investigation helps reduce referrals, and ensures any referrals are appropriately directed. Any reduction of activity achieved by Stahmis may easily be lost in the noise of general referral activity and demand fluctuation.

24 Local GP Feedback on Stahmis (59 GPs responded) 0-100% scale was used A delayed scan might result in: More expensive care 72% Increased cost to the PCT 81% Referral to OOH 84% Referral to physio 74% Referral to Surgeon 74% Earlier demise 65% Worse morbidity 70% More radical surgery 61%

25 I value the service from Stahmis 98% I am happy to wait longer for a scan to save money 22% I am happy to have a capped monthly allowance 20%

26 STAHMIS Questionnaire January local GPs responded to our detailed questionaire

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29 Suggested Solutions to reduce activity Increased Triage using new Software designed by iRadiology – see attached document. Includes: Text recognition radiology advice Detailed information on imaging choices Instant online access to consultant iphones for text or voice support Education – Connect meeting Cost of scan published on web page Enhancement of existing triage Creation of a waiting list creates a one off saving

30 Vetting and Referral Criteria

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34 i-phone radiologist on-call

35 Some potential costs of late diagnosis Stahmis already cheaper than acute sector because of 17% MFF Average Stahmis cost £58.50 HUC attendance£59 A&E attendance£105 OPA 1 st appt£150 6 sessions physiotherapy£378 Six sessions chemotherapy£2,136 Eight sessions radiotherapy£3,608

36 Final thoughts Stahmis is a responsible, well-respected, consultant-led service, that acknowledges the need for increased demand management. We have uncovered a stable, un-met demand for scanning. Scan frequency is static and not increasing Scans are performed more cheaply than in the acute sector We feel that common sense, (and clear GP feedback), states that there are significant savings made by reliable prompt scanning. These savings are hard to pinpoint and quantify.

37 If we cap DIAGNOSTIC referrals, who shoulders the blame and cost for a late diagnosis? What is the cost of – increased morbidity, – increased out patient referrals, – late diagnoses, – increased GP stress – and increased patient anxiety. – Premature death

38 Stahmis : Has uncovered an un-met ultrasound need from local GPs Has now reached a steady state activity Is extremely well received by: – Patients – And GPs Is identifying and treating conditions early Is saving money by appropriate referral Is saving money by early referral Dr Julian Godlee (GP lead Stahmis) Dr Ash Bhagat -Consultant Radiologist (Clinical Lead Stahmis)


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