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

Overview Background Developing ambulatory care Outcomes Future plans

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

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

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

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

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

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

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

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

Ambulatory Care Patients

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= 13.25 days

Ambulatory Care Patients

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

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%

Outcomes Patient experience

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)