Cervical Smears and the 14 day Turnaround: Working across organisational boundaries
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Transcript of Cervical Smears and the 14 day Turnaround: Working across organisational boundaries
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Karen McCleod, Sandwell and West Birmingham Hospitals NHS Trust
Richard Johnson, Pan Birmingham Cancer Network
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Cervical ScreeningBackground
‘The cervical screening programme will ensure that all women receive the results of their screening tests within two weeks by 2010’
Cancer Reform Strategy, DH, Dec2007
‘Seize (or create) a crisis to motivate action across your firm’
Womack & Jones. (2003) ‘Lean Thinking’
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Baseline
Up to 7 week turnaround time (approx)
Delays throughout the process5 days to send the
letter? Days to receive
the sample in Lab
0
100
200
300
400
500
600
700
0 1 2 3 4 5 6 7 9 10 14 15 18 19 21
Sam
ples
Days
Days between sample taken and arrival at Lab (Sept 09)
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HowValue stream mapping
Helps you to see the flowHighlights ‘waste’Forms basis of an implementation plan
Data – highlights where issues are!
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14 day turnaround1
2 3 4 5Sample taken
6 87
9 10 11 12 13 1514
16 17 18 19Results received
20 2221
23 24 25
M T W T F S S
26 27 28 29
30
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Taking of
sample(Primary
Care)
Screening
(Lab)
Send results(Call & Recall)
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‘value add’ - <4 hours
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•Meetings held at the Cancer Network
(Neutral ground)•Doodle.com
Practicalities
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Karen McCleod, Sandwell and West Birmingham Hospitals NHS Trust
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CommunicationWith PCT’sWith other labsWith primary care/smear takersWith Pan B’ham Cancer Network Service
Improvement Team
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Hub and SpokeCytology labs converted to Liquid Based
Cytology following NICE evaluationProcessing machine - large volumeHospitals grouped together in ‘Hub’ and
‘Spoke’ arrangement
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Improvements in LabSending samples to ‘Hub’ every day instead
of every other dayChanging workflow in lab – batch sizes Involving different groups within the LabNon acceptance policy – working with PCT’s/
QA Reference CentreDiscarding of out of scope samples – working
with PCT’s/ QA Reference CentreSmear taker PIN’s - working with PCT’s/ QA
Reference Centre
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Improvements in LabSending results via electronic link to Shared
Services and PCT – changed timeFHSA sender codes – some belonged to GP’s
no longer practicingCame up as Test after sender ended at PCT
– causes delaysChanged these codes on laboratory system –
saw improvement straight away
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Primary CareElectronic HMR101 request formInvolved in training sessions organised by
PCT’sInput from Pan B’ham Cancer Network
Service Improvement teamFrom Shared Services/PCTFrom Laboratory
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Primary CareGive deadlines for starting to use electronic
formsBUT – even with deadlines some people still
don’t use themOne to one sessions – even this doesn’t work
with some practices
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TechnologyPre-printed HMR101 form –takes all the
patient demographics form the National Exeter system
Staff in the lab don’t have to rely on reading handwriting!
Worked with other labs and the QA centre to get the District of Residence onto the HMR101 forms
Means the result can go directly to the correct PCT
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Future?Set up electronic links with other PCT’s for
few out of area resultsGet all smear takers to use pre-populated
HMR101 formsContinue to work closely with PCT’s and
other labs
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