Dr Matt Evison talks about the award-winning RAPID programme

Lung cancer is the biggest cause of premature death in Greater Manchester. The Multi-Disciplinary Lung Cancer Team, led by Dr Richard Booton at the North West Lung Centre, Wythenshawe Hospital, has therefore spent the last two years dedicated to transforming its lung cancer pathway.

This has involved the complete redesign of the specialist and complex service, to what is now known as the RAPID (Rapid Access to Pulmonary Investigation and Diagnosis) Programme.

Lung cancer diagnosis is complex and requires multiple tests.  The current cancer pathway targets set a maximum waiting time of 62-days from patient referral to treatment – and also sets a target of 85% compliance. Yet, across the UK these targets are not being met.

The core aim of the RAPID Programme was therefore to speed up access to diagnostics, eliminate unnecessary delays, and improve the experience and quality of care for patients with suspected lung cancer – potentially resulting in improved survival.  Our overarching vision was to provide the type of care we would expect for our own families and loved ones.

Central to the RAPID Programme is next-day access to CT imaging (following a referral for suspected lung cancer) – together with same-day hot reporting and clinical review. In patients that do not have lung cancer, this significantly reduces the anxiety of ‘not knowing’. For those in whom lung cancer is suspected we can immediately commence a protocolised investigation pathway consisting of test bundles.  This requires a dedicated patient navigator to coordinate appointments from multiple departments – which involved a great deal of collaborative working and good communication. Daily percutaneous image guided biopsy and daily EBUS services maintain the ‘next day ethos’ of the service. We also undertake a daily virtual board round of all patients on the pathway so that any test results are viewed and timing of MDT discussion and follow-up is appropriately planned. However, setting up the Programme was not without its challenges. The Programme has no control over access to PET scanning and lack of PET provision on-site prevented same-day planning for necessary tests.

The introduction of the RAPID programme has dramatically enhanced the efficiency of the front-end of the lung cancer pathway. Prior to this, of those in the 2-week referral pathway, 0% of patients had their CT scan within four days; 27% had a CT scan within seven days and 74% within 14 days.  Following the implementation of the RAPID Programme, 78% of patients now have their CT scan within four days; 92% within seven days and 99% within 14 days.

In addition, we have also shortened the diagnostic pathway for lung cancer such that 8%, 42%, and 77% of referrals are discussed at MDT – with completed investigations by day 7, 14 and 21, respectively.  This compares with 0%, 8% and 17% prior to the introduction of the RAPID Programme. As a result, 40% of patients received surgery within 14 days of the MDT meeting and we are now working to establish appropriate working practices within thoracic surgery and medical oncology to improve this even further.

With 93% of patients now rating the service delivered through the RAPID Programme as eight out of ten or better, this has confirmed a real improvement in care and an accelerated service for the benefit of patients and their families.

For more information about the RAPID programme and its successes, read our Millimetres Matter report at: http://uklcc.org.uk/our-reports/ or contact Dr Matt Evison  matthew.evison@mft.nhs.uk or Dr Richard Booton richard.booton@mft.nhs.uk directly.

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