Rolling out 23-hour ambulatory care

Autumn 2011

Patient Information and Support Manager Anne Armstrong explains how East Midlands Cancer Network is redesigning the care pathway for breast surgery.

NHS Improvement has adopted 23-hour ambulatory care for breast surgery and is piloting this with cancer networks, including East Midlands Cancer Network| (EMCN). This is part of a wider drive by the Department of Health.

EMCN’s vision is that women undergoing mastectomy and wide local excision (WLE) are discharged as early as clinically appropriate. This has an impact on length of stay, and we aim to reduce this to a maximum of three days for mastectomy patients and 23 hours (or day case) for WLE by December 2011.

Staff engagement

An event was held in February to bring together clinical staff working at each of the network’s Trusts to share best practice and to ask questions away from a clinical setting. The day was very successful, with engagement and representation from consultants, breast care nurses, ward sisters and physiotherapists.

Progress within the Trusts

All eight acute Trusts within the East Midlands are now involved in this project and have reduced the length of stay for mastectomy and WLE patients. Some Trusts are still at implementation stage and some already had 23-hour arrangements in place. So the start point has not been level and quantitative data will be more meaningful in 12 months.

At the Derby Hospitals NHS Foundation Trust, consultants tested a new pathway from October 2008–February 2009. The length of stay was reduced and has continued to improve since implementation. The Trust has now achieved the following outcomes:

- The 23-hour stay model is now firmly embedded in Trust.

- Results of a survey show patients are very happy with the new service.

- The relationship between the Trust and community team has greatly improved.

- Patients discharged after one night increased greatly and is now 70%.

Activities at Burton Hospitals NHS Foundation Trust included:

- having a breast care nurse attend the pre-operative assessment, reiterating the length of stay and giving patients a further opportunity to discuss their care

- having a physiotherapist also attend the pre-operative assessment as well as making a post-operative visit on the ward

- the review of nurse competencies to enable nurse-led discharge

- the review of patient information.

United Lincolnshire Hospitals have gone through their implementation phase and have:

- engaged stakeholders, including patients

- mapped and reviewed current pathways on three hospital sites

- developed a localised network advice sheet for use

Further information

Email Louise Walker|, Local Improvement Lead at the East Midlands Cancer Network.