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Quality improvement measures: effects on rectal cancer tissue biopsy process

Mansoor Akhtar (East Kent Hospitals University NHS Foundation Trust, Kent, UK)
Mohamed Boshnaq (East Kent Hospitals University NHS Foundation Trust, Kent, UK)
Sathyan Nagendram (East Kent Hospitals University NHS Foundation Trust, Kent, UK)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 13 August 2018

88

Abstract

Purpose

Delay in histologically confirming rectal cancer may lead to late treatment as histological confirmation is required prior to chemo-radiotherapy or surgical intervention. Multidisciplinary colorectal meetings indicate that there are patients who require multiple tissue biopsy episodes prior to histologically confirming rectal cancer. The purpose of this paper is to examine a quality improvement (QI) measure’s impact on tissue biopsy process diagnostic yield.

Design/methodology/approach

The authors performed the study in two phases (pre- and post-QI), between February 2012 and April 2014 in a district general hospital. The QI measures were derived from process mapping a rectal cancer diagnostic pathway. The primary outcome was to assess the tissue biopsy process diagnostic yield. The secondary outcome included total breaches for a 62-day target in the pre- and post-QI study phases.

Findings

There was no significant difference in demographics or referral mode in both study phases. There were 81 patients in the pre-QI phase compared to 38 in the post-QI phase, 68 per cent and 74 per cent were referred via the two-week wait urgent pathway, respectively. Diagnostic tissue biopsy process yield improved from 58.1 to 77.6 per cent after implementing the QI measure (p=0.02). The 62-day target breach was reduced from 14.8 to 3.5 per cent (p=0.42).

Practical implications

Simple QI measures can achieve significant improvements in rectal cancer diagnostic tissue biopsy process yields. A multidisciplinary approach, involving process mapping and cause and effect modelling, proved useful tools.

Originality/value

A process mapping exercise and QI measures resulted in significant improvements in diagnostic yield, reducing the episodes per patient before histological diagnosis was confirmed.

Keywords

Acknowledgements

The authors thank Paul Bassett, Consultant Statistician, for his help reviewing and analysing the data; Paula Morgan, Endoscopy Department Matron, for her support when implementing the QI measures; and Dr Paul Stevens, Consultant Renal Physician, for reviewing the manuscript.

Citation

Akhtar, M., Boshnaq, M. and Nagendram, S. (2018), "Quality improvement measures: effects on rectal cancer tissue biopsy process", International Journal of Health Care Quality Assurance, Vol. 31 No. 7, pp. 775-783. https://doi.org/10.1108/IJHCQA-06-2017-0097

Publisher

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Emerald Publishing Limited

Copyright © 2018, Emerald Publishing Limited

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