Case study summary
The multidisciplinary diagnostic centre (MDC), at University College London Hospital (UCLH), opened in 2016 and delivers faster diagnosis and improved patient journey with support from a Clinical Nurse Specialist (CNS), to patients presenting with complex or vague abdominal symptoms.
The UCLH MDC model uses early and effective CNS triage of patients; fast and coordinated investigations; and access to a range of specialists to deliver faster diagnosis to patients. There are a number of different MDC models – UCLH has found this service best suited to its cancer healthcare system.
The service model
GPs and other healthcare professionals refer patients by email to the MDC if they suspect gastrointestinal (GI) cancer. Particularly if they have a patient who requires an urgent diagnosis which shouldn’t wait more than a few days. The service is based on the new rapid diagnostic pathway, using a five part referral criteria:
- new unexplained abdominal pain
- unexplained weight loss
- painless jaundice
- new and persistent unexplained nausea / loss of appetite
- GP gut feeling or concern that there is underlying GI cancer.
The Pathway Coordinator receives the referral and supports the CNS to triage each patient and provide a fast-track diagnosis service to those who are difficult to diagnose.
Normally, patients needing diagnostic services attend the MDC within two or three days of referral. At the MDC the CNS will take a detailed medical history and complete the appropriate blood tests. Patients requiring a CT scan will be given an appointment to return for their CT scan in a couple of days.
The results of the patient’s investigations are reviewed by the CNS. They will telephone those patients who do not have cancer to discuss their results and provide tailored advice about prevention as appropriate. The journey for patients who do not have cancer will end with either a referral to an appropriate GI consultant or back to their GP.
The multidisciplinary team, led by the GI consultant, discusses all the patients where there is a suspicion of cancer. As a result of these discussions the CNS might contact their patients to organise further investigations.
When a diagnosis of cancer is made, the patient is invited back to the MDC to see the consultant. The consultant will talk the patient through their diagnosis and quickly refer the patient to start their cancer treatment through the appropriate pathway.
- Patients with cancer are diagnosed quickly, referred for appropriate treatment and start treatment much more quickly
- Patients presenting with complex and/or vague abdominal symptoms, are quickly triaged and invited for necessary investigations in a coordinated way
- All of the investigations are completed on the same site, by staff who are fully informed of their patient’s medical history
- Patients have access to support from the CNS from referral through to diagnosis
- Many patients are quickly reassured that they do not have cancer, as well as receiving a prompt referral to the appropriate clinician and advice on cancer prevention where appropriate.
It is too soon to measure the results of the pilot in terms of impact on the two week urgent cancer waiting times standard – catching cancers earlier, diagnosing fewer cancers in A&E and reducing hospital visits. However, the team at the MDC have seen:
- Patients diagnosed and appropriately referred for treatment quickly
- Increased uptake in GP referrals, as experienced GPs who are concerned about their patient now have an appropriate referral pathway
- Early stage cancers diagnosed in patients who ordinarily might be missed due to complex or vague symptoms
- Late stage cancers diagnosed in patients who may have otherwise presented at A&E
- Patients diagnosed with, and referred for treatment, for other non-cancerous life threatening conditions.
Gudula Khan from Hampstead was referred to the University College Hospital multidisciplinary diagnostic centre in November 2017 by her GP.
Mrs Khan said: “I had a routine blood test for diabetes at my GP surgery and then received a call from the practice to say I was very anaemic. My GP was concerned that it could be something serious, even though I felt fine, and she insisted on referring me to the multidisciplinary diagnostic centre at UCLH for a fast diagnosis. At the MDC I met Vicky, the nurse, who asked me some questions and arranged for me to have a CT scan as well as an endoscopy and colonoscopy the following week. The consultant told me that I had bowel cancer and I would need an operation. The operation was successful – I was lucky that the cancer hadn’t spread to any other parts of my body and I didn’t need chemotherapy afterwards.
“I had no outward symptoms of bowel cancer and feel incredibly lucky that a routine blood test flagged that there could be a problem to my GP. I am so grateful to the MDC service at UCLH for being available to make sure I could receive a speedy diagnosis and get my cancer treated quickly.”
David Graham, consultant gastroenterologist at UCLH, said: “The MDC provides a fast-track patient centred approach to improve the care of patients who have worrying symptoms. Through the MDC we are able to improve the patient journey so that they benefit from prompt clinical review, appropriate investigations and a diagnosis all within 28 days. This unique service recognises the flaws in existing patient referral pathways and provides patients and their GPs the support required when it is needed most with the important aim to diagnose cancer at an earlier stage and improve patient outcomes.” David Graham, consultant gastroenterologist at UCLH
Vicky Megias, clinical nurse specialist at UCLH, said: “My role enables patients to be triaged and assessed promptly from referral, ensuring investigations are initiated and clinical findings acted on. I am a constant source of contact during the pathway for not only patients but also referring clinicians. I coordinate referrals to the greater MDT and ensure clinical outcomes are acted on and communicated.”
- To make the MDC work, it is important to have the right staff in place and to look at the structure of how the team will work
- To enable timely coordination of all the necessary investigations it is important to have access to various other and teams and services. For example, we have several daily slots available, to book in our patients for CT scans.
There are ten pilots trialling models of earlier and faster diagnosis. Five of these (including the model at UCLH) are jointly funded by Cancer Research UK, Macmillan and NHS England.