Reducing first appointment delays for electron radiotherapy patients by improving the treatment planning pathway: a quality improvement project

Clatterbridge Cancer Centre (CCC) is a specialist hospital trust in England with three sites. Delay to the start of an appointment for radiotherapy, especially the first appointment (a ‘New Start’) is poor, both for operational efficiency and patient experience, causing stress for both patients and staff. Our aim is for the New Start to begin within 30 min of the allotted appointment time. To this end, we established another aim: for ‘Final Checks’ to the radiotherapy plan to be completed at least 30 min prior to the New Start appointment time. Prior to this quality improvement (QI) project, only 33% of electron-treatment New Start appointments started within the target 30 min (the average delay was 52.4 min) and only 48% of the corresponding Final Checks had been completed by their 30 min prior target. The treatment pathway for these patients was redesigned, with the aim of 90% of New Start appointments starting within 30 min of the allotted appointment time. By the end of this QI project, 69.2% of New Start appointments started within 30 min of the appointment time (with average delay reduced to 27.2 min), and 92.3% of Final Checks were completed by their 30 min prior target. We also reduced the number of safety (Datix) incidents due to plan not ready from 10 to 0. A year after the project, we have held most of the time improvements and still have had 0 plan-not-ready Datix. The largest improvement was achieved by introducing a proxy (without the patient present) ‘day 0’ appointment. This takes place in advance of the New Start appointment to enable earlier planning. Subsequent improvements included: automating previously manual planning calculations, making the care path consistent with other external beam radiotherapy care paths at CCC to reduce staff cognitive load and sharing key performance data with staff.