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![Page 1: Development and Health Economic Evaluation of a Novel Ambulatory Haematological Cancer Service. Dr Christopher Dalley Department of Haematology Sheffield.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649c9d5503460f9495bbdd/html5/thumbnails/1.jpg)
Development and Health Economic Evaluation of a Novel Ambulatory
Haematological Cancer Service.
Dr Christopher DalleyDepartment of Haematology
Sheffield Teaching Hospitals NHS Foundation Trust
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Overview
• Background
• Developing ambulatory care
• Outcomes
• Future plans
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![Page 4: Development and Health Economic Evaluation of a Novel Ambulatory Haematological Cancer Service. Dr Christopher Dalley Department of Haematology Sheffield.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649c9d5503460f9495bbdd/html5/thumbnails/4.jpg)
The Royal Hallamshire;Clinical Haematology
• Bone marrow transplant programme
• Largest treatment centre for blood cancer in S.Yorkshire
• Two inpatient wards and large day care ward
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The problem;blood cancer care
• Intensive chemotherapy
• Side effects
• Lengthy inpatient stay
• Increasing demand
• Treatment closer to home
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The solution
• Ambulatory care
– Deliver key parts of patient care in day case or home environment
– Reduce or avoid inpatient stays where possible
– Deliver care safely
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What we aimed to do
• Introduce new ambulatory care treatments– Patients with acute leukaemia (AML)– Patients with lymphoma needing high-dose therapy
• Clinical microsystems
• Evaluate – Economic impact– Patient experience
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Implementing ambulatory pathwaysClinical microsystems
• Microsystems team– Patients, nurses, doctors, pharmacist, hotel services,
managers, health economist
• Training
• Weekly meetings
• Tools– PDSA, questionnaires, news clips,– Process mapping
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Process mapping
Chemo
Support
28 days
Patient stays in flat/home
Ambulatory pathway
Chemo Support
Patient stays in ward
Normal inpatient pathway
28 days
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Supporting the ambulatory pathways• New protocols and guidelines
• Patient & carer education programme
• Patient information booklets
• Patient alert card
• Ambulatory flats and hotel services
• Longer day ward opening hours including weekends
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![Page 12: Development and Health Economic Evaluation of a Novel Ambulatory Haematological Cancer Service. Dr Christopher Dalley Department of Haematology Sheffield.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649c9d5503460f9495bbdd/html5/thumbnails/12.jpg)
OutcomesAmbulatory patients with AML
Patient Age Days ambulatory
Days inpatient
Reason for readmission
1 23 38 3 Nausea and vomiting
2 65 23 10 Not applicable
3 35 419
176
InfectionNot applicable
4 58 14 7 Not applicable
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Ambulatory Care Patients
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Outcomes Ambulatory patients with lymphoma
Patient Age Days ambulatory
Days inpatient
Reason for readmission
5 28 11 9 Sore mouth
6 42 16 4 Infection
7 63 12 24 Sore mouth
8 66 14 10 Sore mouth
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Ambulatory Care Patients
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OutcomesHealth-economic
• School of Health and Related Research (ScHARR)
• Computer simulation used to assess impact of introducing new ambulatory care pathways alongside standard care pathways in a clinical unit.
• Various simulations used to measure effect of different degrees of ambulatory care
• Unit costs for ambulatory and standard pathways provided by RHH management team
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Effect of ambulatory care provision on bed days and care costs
1 flat 2 flats 1 flat & home care
2 flats & home care
Reduction in bed days per
year
342 453 521 521
Reduction in costs
£54,210 £65,185 £81,823 £74,409
Percentage reduction in
costs
7.1% 8.6% 10.8% 9.8%
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OutcomesPatient experience
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Establishing ambulatory care
• Department to write full business case to support ambulatory care:– Second ambulatory flat refurbished– Ambulatory co-ordinator post to be appointed
• Presenting our findings:– Local (Cancer Board Haemato-oncology group)– Nationally (Shelford group)– International-(EBMT Geneva, April 2012)