Radiotherapy Waiting List Management:

Introduction

The New Zealand Experience z

Welcome to New Zealand

z

Causes of waiting lists

z

The New Zealand approach to waiting list recording and management

z

Colonel Roger Fray

Rob Hallinan Clinical Resource Radiation Therapist Waikato Hospital Hamilton New Zealand

Ethnicity European Maori Asian Pacific Islanders Others

Key Stats z

18000 new cancer registrations per year

z

8000 deaths/year

z

7200 patients treated with radiotherapy/year

Waiting Lists: The New Zealand Experience

Oncological Sites where delay in Radiotherapy has resulted in increased local recurrence rates z z z z z z z

Head and Neck High Grade Gliomas Breast Cervix NSCLC Soft Tissue Sarcomas Oesophagus

Waiting List Causes z

2006 Referrals 300

Demand

250

z

Supply z

z z

z z

200

Resource Human Equipment

150

Process Clinical

100

50

0 January

February

March

April

May

June

July

August September October November December

Month

Resource Factors

The Multidisciplinary Team

Equipment

z

Radiation Oncologists

z

Treatment Capacity

z

Medical Physicists

z

Networking

z

Radiation Therapists

z

Immobilisation

z

Engineers

Process Factors z

Small team

Value Time/Real Time Ratio z

Value Time z

z

Reduction in handovers

z

The time spent working on a product

Real Time z

The total time of the product in the system

Radiotherapy Booking Criteria

Clinical Factors z

z

(from decision to treat)

Fractionation z

Breast

z

Bony metastases

z

Prostate HDR

Complexity Source: NZROAC Report 1999

Pitfalls z

Joint reporting of adjuvant and palliative patients

z

Inconsistency of application

z

Too simplistic?

z

Needs revision?

Wait List Reporting Criteria 2002 z

Referral to FSA

z

FSA to Start of Rx

z

Referral to Start of Rx

Waikato DHB Cancer Centre Summary Priority A (Urgent)

Recommended Guidelines RefRef-FSA

FSAFSA-Rx

Priority C (Palliative and other radical)

Priority D (Combined chemotherapy and radiation treatment)

Dec-07 Priority A

Assessment

Category

Priority B (Curative)

A. Numbers waiting for first specialist assessment

RefRef-Rx

Urgent