When nurse practitioner (NP) James Veenstra reviewed patient data for lung cancer treatment, he discovered patients waited 180 days to undergo surgery after their CT scan – well outside of recommended treatment guidelines. Health-care professionals had limited resources to advocate for improving treatment times. However, all that changed when in 2011, the journal The Lancet published results of a study on data for cancer survival rates. The research indicated that Alberta had the lowest survival rate for patients diagnosed with lung cancer among the four Canadian provinces included in the study. The journal’s report combined with James’ research on treatment times caused health-care decision-makers to stop and listen.
James and surgeon Ken Stewart worked together on a proposal and received funding for a three-year trial of the Alberta Thoracic Oncology Program (ATOP). The program was designed to provide appropriate, multidisciplinary and expedited care of patients with suspected lung cancer. ATOP would need to demonstrate significant benefits to ensure ongoing funding after the trial period.
James says the funding ensured the program could be properly evaluated. “We are able to track how long it takes for people to come see us, get an operation, and get specialized testing such as biopsies. Previously, we would just estimate the time.”
James helped pull together a team of professionals with expertise in oncology, nursing and pulmonary/respiratory health. They brought together three important pieces of the program to reduce the time it takes for patients to receive the care they need: early warning alerts, quicker referrals and getting patients to see the right health-care professionals.
One of the delays identified by the team was that a patient’s CT scan, even one suspected of presenting lung cancer, often sits on a specialist’s or family doctor’s desk for a period of time before being reviewed.
The program introduced an alert system. Radiologists who suspect a scan indicates lung cancer can digitally flag the scan, which automatically alerts ATOP. A program NP reviews the flagged CT scans the next day and determines whether the patient is a candidate to receive support from ATOP. If so, the NP contacts the provider who ordered the CT scan for the patient, and asks whether they’d like the patient to be involved in the program.
“If they want us involved, they have to inform the patient of what's going on, send us a medical history and then we'll take care of investigations into treatments, and we'll see them in a timely manner,” describes James.
The ATOP team has just finished analyzing two years of data and have discovered the alerts make a significant difference, getting patients to their program and treated earlier.
“To date, over 3,000 patients have been flagged for our program through this process,” says James.
Nurse practitioners work in the Rapid Assessment Clinic. They’ll see patients the next day if a referral indicates a patient needs immediate investigation or treatment.
“We make a conscious effort to see them as soon as possible and get expedited treatment in terms of diagnosis,” says James. “And then we communicate quite closely with the Cross Cancer Institute and we're able to get them seen in a timely manner as well.”
Nurse practitioners like James play a key role by directing patients to the right health-care professionals. They help guide patients to the appropriate specialists and arrange testing before patients are seen in the clinic, helping to improve wait times.
“The whole point of our program is to provide timely and effective care for patients,” says James. “Being able to collaborate and access patients ultimately improves patient care.”
The variety of specialists in the program allows patients to see the right health-care provider. The nurse practitioners work closely with thoracic surgeons and respirologists.
“Working collaboratively with specialists who have these skill sets makes it easy to seamlessly transfer patients from one area to another,” says James. “That really helps avoid time delays and I think it’s a very effective use of resources as well.”
There are 11 thoracic oncology surgeons in Alberta; it’s a specialized service not easily accessible to people living in rural areas.
“We found that rural patients are delayed in being referred to our program compared to patients that live in the city,” says James. This may be due to having less access to family doctors, reluctance to travel to the city or other factors.
As a result, the radiology alerts have been rolled out to areas outside of Edmonton including the Alberta Health Services northwest Alberta zone (Grande Prairie) and central zone (Red Deer).
“We're waiting to see how things go with Red Deer before rolling it out to Fort McMurray and area,” says James.
James was nominated for the 2017 CARNA Award of Nursing Excellence for being an outstanding clinician. He has played a pivotal role in improving access to care for lung cancer patients, all while demonstrating collaborative, critical thinking and process improvement skills.