Case studies

SuperFit for purpose

InfoFlex PSA Tracker at Royal Devon and Exeter NHS Foundation Trust.

Monitoring of prostate cancer in patients in an efficient and timely manner – The InfoFlex Prostate-Specific Antigen (PSA) tracker which monitors prostate cancer patients in a stable state in their post-cancer treatment phase, was introduced by the Royal Devon and Exeter (RD&E) NHS Foundation Trust in order to cope with an ongoing increase in capacity.

Key potential improvements after PSA tracker introduction

Quality

  • Conveniently managed patient self-monitoring
  • Time saving through remote monitoring, avoiding financial loss and undue stress for patients
  • Increased freedom for patients with a stable condition

Efficiency

  • A solution to expanding capacity within the department
  • Frees up consultant time for patients in greater need of care
  • Quick completion of initial project phase
  • Predicted to help meet targets more easily and save money

Ease of use

  • Clear and regular communication between InfoFlex and RD&E NHS Foundation Trust ensured any problems were resolved quickly
  • Good initial feedback received from patients
The PSA tracker

The PSA tracker monitors prostate cancer patients in their post-cancer treatment phase. Eligible patients are stable for a substantial period of time before potential relapse; for example, those undergoing follow-up after surgery or radiotherapy, or patients receiving ongoing treatment such as hormone therapy.

Patients have their blood taken at their GP surgery and this is then logged onto the PSA Tracker. If the blood sample is normal the patient will receive a call or letter from a Clinical Nurse Specialist offering self-monitoring advice. Abnormal or unexpected results will trigger a range of responses including an appointment to see a specialist if necessary.

Issues addressed

Continually expanding capacity within the RD&E Trust’s urology department meant that it became impossible for them to continue using their current manual follow-up system. National Cancer Survivorship Initiative (NCSI) guidelines make it necessary to assess alternative ways to manage patients, along with possible ways to enable patients to manage themselves.

Urology Clinical Nurse Specialist (CNS), Claire Turner, said, “We had to look at a better method of following patients up, which was both convenient to the patient and safe”.

Previously, the trust had a manual system that involved seeing patients face to face to assess their PSA level and general health, after which their appointment for their next routine PSA test would be arranged. Whilst these appointments take around ten minutes, the growing number of prostate patients surviving cancer and needing regular follow-up treatment meant there were not enough nurse services to assist and there was limited space in clinics. The issue was particularly relevant for the RD&E Trust as it is situated in a rural county with a particularly high proportion of older men, and there are many patients who need lengthy monitoring, sometimes between five and ten years.

According to Project Manager, Wendi Abraham, a remote monitoring service for prostate patients at the RD&E Trust was long overdue. Consultant Urologist and Cancer Lead for Urology, Mr Malcolm Crundwell, had been looking for a PSA tracker system for at least three years.

Ms Abraham said, “There is increasing evidence which confirms that out-patient appointments (OPA) don’t always add value to the patient experience. For example, for some patients, an OPA can necessitate potentially a 30-60 mile round trip, loss of income, disruption to their week, and increased anxiety for very little return. To improve and enhance the patient experience, by keeping care closer to home, the opportunity to be remotely monitored was overdue and incredibly necessary.

“[We needed] to better manage the capacity issues that we knew were inevitably going to continue to grow nationally and locally.”

Ms Abraham continued, “As a project manager I think communication is the key to most things. Right from the outset we were allocated an account manager within InfoFlex who instigated a can-do attitude. I found the approach refreshing and very supportive.”

Benefits of the PSA tracker

The PSA tracker avoids the need for short, unnecessary consultations for patients only requiring a review of their PSA result. It shifts control back into the hands of patients, who would otherwise be at the mercy of the acute system. Based on feedback from patients at the RD&E Trust, patients who feel able to live their lives as normal — and not as ‘cancer patients’ — enjoy much better overall wellbeing.

Patients experience increased freedom without losing support from the hospital should they need it. If they are concerned about their disease process, they can contact the CNS, who can then quickly bring their case to a Multidisciplinary Team Meeting if necessary. This ensures that patients who need further examination are seen, and those who are stable can continue to manage their disease efficiently and easily.

Urology CNS Claire Turner said: “From the CNS point of view, it’s a streamlined process for the patient — not only is it convenient for them not to have to travel to spend 10 minutes to say ‘Yes, you’re fine’, but it also gives them confidence that there’s always somebody that they can contact if they have any symptoms that they are worried are related to the disease.”

The PSA tracker ensures that the right patients are seen by the right people, increasing clinic efficiency, timeliness, and streamlining the treatment process for both patients and trusts.

Project Manager Wendi Abraham said: “Ultimately it will create capacity. It won’t reduce appointments because the demand isn’t going to reduce. That’s always going to continue as more people live with and beyond cancer, but it will create capacity to cope with the demand in a more timely way.”

Looking ahead

Initial feedback from patients has been promising. A quote from a patient provided via HNA in April 2015 said, “I am well and free from pain, my doctor is pleased and my cancer seems in remission, but I am particularly grateful for the PSA tracker to keep an eye on things.”

The trust is now focusing on ensuring that patients and staff continue to benefit fully from the new system. They are working towards incorporating other oncology and bladder patients into the tracker, and have also received a lot of interest from other specialisms such as IBD with meetings scheduled with haematology next month.

As the RD&E Trust is still in the early stages of the project they remain cautious. However, staff agree that the PSA tracker should continue to progress in a positive way. After having looked at existing PSA trackers, for example in Bath and Bristol, the progress that has been made since these first systems is encouraging. However, it is too early for the trust to accurately predict whether or not the tracker will help them meet targets more easily or save money.

Ms Abraham said: “If the predictions are anywhere close to what we have already covered from the analysis work we did last year, [progress] will be considerable.”

“We have gone through the teething problems and overcome the vast majority of challenges. The fact that the tracker has been designed in a way that talks to our other systems is fantastic. It’s still early stages, but it is about patient experience, and if there is any way we can enhance the quality of that then it’s all worthwhile” commented Ms Abraham.

Download: