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Dr Christopher Dalley Department of Haematology

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Presentation on theme: "Dr Christopher Dalley Department of Haematology"— Presentation transcript:

1 Development and Health Economic Evaluation of a Novel Ambulatory Haematological Cancer Service.
Dr Christopher Dalley Department of Haematology Sheffield Teaching Hospitals NHS Foundation Trust

2 Overview Background Developing ambulatory care Outcomes Future plans


4 The Royal Hallamshire; Clinical Haematology
Bone marrow transplant programme Largest treatment centre for blood cancer in S.Yorkshire Two inpatient wards and large day care ward

5 The problem; blood cancer care
Intensive chemotherapy Side effects Lengthy inpatient stay Increasing demand Treatment closer to home

6 The solution Ambulatory care
Deliver key parts of patient care in day case or home environment Reduce or avoid inpatient stays where possible Deliver care safely

7 What we aimed to do Introduce new ambulatory care treatments
Patients with acute leukaemia (AML) Patients with lymphoma needing high-dose therapy Clinical microsystems Evaluate Economic impact Patient experience

8 Implementing ambulatory pathways Clinical microsystems
Microsystems team Patients, nurses, doctors, pharmacist, hotel services, managers, health economist Training Weekly meetings Tools PDSA, questionnaires, news clips, Process mapping

9 Process mapping Normal inpatient pathway Ambulatory pathway Admit
Chemo Support Home Patient stays in ward Normal inpatient pathway 28 days Admit Chemo Support Home 28 days Patient stays in flat/home Ambulatory pathway

10 Supporting the ambulatory pathways
New protocols and guidelines Patient & carer education programme Patient information booklets Patient alert card Ambulatory flats and hotel services Longer day ward opening hours including weekends


12 Outcomes Ambulatory patients with AML
Age Days ambulatory Days inpatient Reason for readmission 1 23 38 3 Nausea and vomiting 2 65 10 Not applicable 35 4 19 17 6 Infection 58 14 7

13 Ambulatory Care Patients

14 Outcomes Ambulatory patients with lymphoma
Age Days ambulatory Days inpatient Reason for readmission 5 28 11 9 Sore mouth 6 42 16 4 Infection 7 63 12 24 8 66 14 10 Mean AC stay= days

15 Ambulatory Care Patients

16 Outcomes Health-economic
School of Health and Related Research (ScHARR) Computer simulation used to assess impact of introducing new ambulatory care pathways alongside standard care pathways in a clinical unit. Various simulations used to measure effect of different degrees of ambulatory care Unit costs for ambulatory and standard pathways provided by RHH management team

17 Effect of ambulatory care provision on bed days and care costs
1 flat 2 flats 1 flat & home care 2 flats & home care Reduction in bed days per year 342 453 521 Reduction in costs £54,210 £65,185 £81,823 £74,409 Percentage reduction in costs 7.1% 8.6% 10.8% 9.8%

18 Outcomes Patient experience

19 Establishing ambulatory care
Department to write full business case to support ambulatory care: Second ambulatory flat refurbished Ambulatory co-ordinator post to be appointed Presenting our findings: Local (Cancer Board Haemato-oncology group) Nationally (Shelford group) International-(EBMT Geneva, April 2012)

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