Ambulatory haematological cancer service Sheffield Teaching Hospitals NHS Foundation Trust

The Sheffield Teaching Hospitals team developed ambulatory care treatment pathways for blood cancer patients. Ambulatory care involves delivering care on a day case basis or at home. The aims of the project were to:

• reduce length of inpatient stay
• minimise delays in treatment delivery
• increase bed capacity
• enhance the patient experience.

The team used Clinical Microsystems as a service improvement tool to design the treatment pathways and to engage staff and patients in the process. They developed a range of resources and services including:

• new protocols and guidelines
• a patient and carer education programme
• patient information booklets
• a patient alert card
• ambulatory care flats and hotel services
• extended opening hours for the day ward including on weekends.

Who was involved

The Clinical Microsystems team involved doctors, nurses, patients, managers and hotel services, along with a health economist and a pharmacist. The economic impact of the project was led by Sheffield School of Health and Related Research.

Outcomes

The team treated 13 blood cancer patients using ambulatory care pathways between April 2011 and February 2012. All patients treated gave positive feedback. 

Ambulatory care significantly reduced the median inpatient length of stay for:

• acute myeloid leukaemia patients receiving consolidation chemotherapy - 7 days compared to 25 days for standard inpatient treatment
• lymphoma patients receiving high dose therapy with stem cell support - 9.5 days compared to 21 days.

Computer simulation modelling predicted that ambulatory care could enable the unit to perform an additional 6-10 bone marrow transplants each year and reduce yearly treatment costs by 7-11%.