Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
MY Lim (1), YC Yeung (2)
Affiliation :
(1) Department of Oncology, (2) Department of Medicine, Princess Margaret Hospital
Introduction :
Early cancer diagnosis is important to improve survival and enhance patients’ experience. An audit in 2018 within Princess Margaret Hospital showed a waiting time of 5-23 weeks from referral to lung cancer diagnosis. A new OSDC was set up in August 2021 to provide diagnostic procedures as bundled same date or fast-track services for patients with high suspicious of lung cancers. Patients were recruited by standardized cluster-based triage pathway and streamlined care with multidisciplinary assessment by Oncologists, Respiratory Physicians, Radiologists, Cardiothoracic Surgeons and Pathologists was provided through specialty nurse coordination.
Objectives :
1. To expedite the diagnostic process and increase the diagnostic accuracy for patients with high suspicious of lung cancers
2. To enhance patients’ experience in cancer journey
Methodology :
This is a retrospective study to review the performance of the OSDC in terms of lung cancer diagnostic rate, waiting time to diagnostic tests, time-to-diagnosis and patients’ satisfaction.
Result & Outcome :
Between August 2021 to August 2023, a total of 207 patients were recruited at a median waiting time of 13 days (90 percentiles = 29 days). Median age was 67 (range 44-93) and with male predominance (62% vs 38%). Around two-third (64%) were referred from specialty out-patient clinics and 76% had cross-sectional imaging prior to first assessment. Same date diagnostic procedures including computer-tomography, bronchoscopy with endoscopic ultrasound and bedside ultrasound-guided lung biopsy were arranged in 44%, 54% and 22% of patients. Additional fast-track diagnostic procedures including image-guided lung biopsy, positron emission tomography and lung function test were arranged in 21%, 37% and 38% of patients with a median waiting time of 20 days, 14 days and 8 days. After excluding 20 patients who declined or defaulted work-ups, the diagnostic rate of primary lung cancer was 75%. Majority (90%) were diagnosed within 34 days (range 0-76) and at first diagnostic attempt (85%). Among them, 56% had non-metastatic disease and 80% received curative treatment. Over 90% of patients were either satisfied or very satisfied with this clinic in terms of providing support and respect, understand their needs and lessen their worries. To conclude, One-Stop-Diagnostic-Clinic for patients with high suspicious of lung cancers successfully enhanced patient-centered care by achieving early diagnosis and with high patient satisfaction through coordinated cluster-based multidisciplinary care.
