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Development and Health Economic Evaluation of a Novel Ambulatory Haematological Cancer Service .

This study focuses on the development and evaluation of an ambulatory care service for haematological cancer patients, aiming to reduce inpatient stays and improve patient outcomes. The study assesses the economic impact, patient experience, and clinical outcomes of implementing ambulatory care pathways in a clinical unit.

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Development and Health Economic Evaluation of a Novel Ambulatory Haematological Cancer Service .

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  1. Development and Health Economic Evaluation of a Novel Ambulatory Haematological Cancer Service. Dr Christopher Dalley Department of Haematology Sheffield Teaching Hospitals NHS Foundation Trust

  2. Overview • Background • Developing ambulatory care • Outcomes • Future plans

  3. 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

  4. The problem;blood cancer care • Intensive chemotherapy • Side effects • Lengthy inpatient stay • Increasing demand • Treatment closer to home

  5. 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

  6. 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

  7. 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

  8. Process mapping Normal inpatient pathway Patient stays in ward Admit Chemo Support Support Home Home Admit 28 days 28 days Ambulatory pathway Chemo Patient stays in flat/home

  9. 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

  10. OutcomesAmbulatory patients with AML

  11. Ambulatory Care Patients

  12. Outcomes Ambulatory patients with lymphoma

  13. Ambulatory Care Patients

  14. 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

  15. Effect of ambulatory care provision on bed days and care costs

  16. OutcomesPatient experience

  17. 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)

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