Novel IT systems for adrenal lesions to enhance safety & effectiveness
- Shortlisted idea
Meet the team
- Drs George& Clark (Radiologist, UHNM)
- Dr Issa (Endocrinologist, Manchester University)
- Dr Heald (Endocrinologist, Salford Royal Hospital/)
- Gill Powner, Endocrine nurse, UHNM
- Helen Robertson, MDT Co-ordinator, UHNM
- Mrs Web, Manager, UHNM
- Prof Sim (Statistician). Keele University
- Prof Fordham (Health Economist, East Anglia)
- Charlotte Woodcock, Qualitative Researcher, Keele
- Dr Lea: R&I Manager
What is the challenge your project is going to address and how does it connect to the theme?
The change: Adrenal lesions are one of the commonest unexpected findings on radiological scans. Through HF support, we developed a prototype adrenal incidentaloma management system (eAIMS). We will enhance eAIMS functionality by:
- Increasing inter-team connectivity (nurses, clinical biochemists, endocrinologists and administrators) to maximise timeliness and efficiency.
- Automating alerts to warn against delayed results, thereby streamlining the patient journey.
- Automating alerts of abnormal results to ensure timely intervention.
This proposal was created through active partnership between patients and multidisciplinary team (MDT) members.
- Time-in-motion analysis (see Hanna, et al. BMJ Open Quality. 2020:9.pii:e000572)
- Focus group discussions with affected patients.
- Ongoing discussions between MDT and IT experts regarding safety risk of manual data entry and benefits from automated alerts.
- Feedback following national presentations (Association of British Clinical Diabetologists, Caledonian Endocrine Society), with colleagues’ insight into enhancing eAIMS functionality.
What does your project aim to achieve?
Safety/timeliness: time from test request to actioning results (20% reduction)
- Efficiency: hands-on time for key staff groups (time-in-motion study)
- Timeliness: Shorter overall patient journey:
- referral -> investigation request
- request -> completed investigation
- completed investigation -> MDT decision
- Cost-effectiveness: reduced costs (time-in-motion analysis), utilising established tool (see Hanna et al. BMJ Open Quality. 2020:9.pii:e000572)
- Qualitative analysis:
- Patient experience: focus group discussions (existing practice versus updated eAIMS-supported pathway)
- Clinician evaluation: Qualitative interview (acceptability and confidence of using eAIMS, clinician well-being/stress).
- Shorter patient journey: Prototype eAIMS reduced complex case journey by 78%. Upgraded version will streamline pathway for all cases (delayed/abnormal results alerts).
- Enhanced patient safety: Minimising human errors (electronic data entry & letter generation), highlighting potential delays in testing (automated alerts).
- Reduced patient anxiety: Cutting waiting time, and associated uncertainty.
- Cost-effectiveness: Reducing hands-on time & unnecessary clinic visits.
- Facilitate scaling-up: Additional functionality will promote national adoption.
Reducing health inequalities:
Unified approach, regardless of unit size/infrastructure.
How will the project be delivered?
- Endocrinology, Clinical Biochemistry, Radiology, Nursing, Administration and patients will develop the system specification.
- Work with IT/Information Governance to enhance eAIMS functionality.
- Test upgraded system (dummy scenarios).
- Implement and evaluate upgraded eAIMS over 6 months.
Statisticians, health economists, qualitative researchers) will assess impact on patient safety, timeliness, efficiency and cost-effectiveness, whilst also collecting patient and clinician perspectives.
Delivering value for money:
Utilising our previously-established Adrenal Incidentaloma Intervention Cost Assessment Tool (AICAT; Hanna et al. BMJ Open Quality. 2020:9.pii:e000572), we will assess cost-effectiveness of the improved pathway utilising data from the time-in-motion analysis.
- Project Operational Group: manage day-to-day operational challenges.
- Project Steering Group (including patient representation): oversees overall project trajectory and reviews risk.
How is your project going to share learning?
The eAIMS programme represents an initiative whereby both patients and clinical stakeholders co-develop an electronic portal for the management of patients with adrenal lesions. Our aim is for this to be:
An ‘Iterative Patient-driven Service Adaptation Process’, whereby patients are continually involved in ongoing improvements to the pathway.
- A vehicle to facilitate co-developed novel service models including those led by nurses and clinical scientists.
- A platform for an Interactive Online Patient Support System.
- The forerunner of a national registry for such patients, thereby facilitating future national research and audit.
The current proposed upgrade represents the next step in enhancing inter-team connectedness and integration via eAIMS system, rectifying the current disjointed approach. This model is readily transferrable to other conditions, where working across the Q community will enable us to share this journey.
Its web-based approach will also facilitate wider national adoption.
How you can contribute
- Promoter: Help us get our idea noticed and champion the spread to other centres.
- Expert: Support: from clinical colleagues and those with IT improvement skills
- Critical friend: Positive feedback to help us improve the system
- Networker: Help us link with other centres and experts
- Collaborator: Develop opportunities to be involved in adoption and scaling up
- Investor: Facilitate linking with IT enterprises to support scaling up and national adoption
- Fixer: Signpost extra resources to enhance functionality and facilitate scaling up
- Strategist: Align our idea with existing local and national priorities and policies
|2 Sep 2022||12 months|