IMPLEMENTING A BRAIN TUMOUR PRESENTATION PATHWAY

Abstract AIMS Most patients with a new diagnosis of a brain tumour present through the emergency department. Busy de- partments staffed by inexperienced resident doctors may lead to poor patient experience, extended lengths of stay, inadequate investigation, and/or follow up. A patient complaint highlighted the benefits of a coordinated pathway. METHODS A brain tumour pathway was developed and expanded to most hospitals in the region through the Merseyside and Cheshire Cancer Alliance. Regional meetings facilitated wide involvement and each hospital was encour- aged to modify the pathway as appropriate for their own institution. Education was provided in person, and funding for local patient tracking was provided. Audits were performed to assess the pathway’s impact. RESULTS All hospitals enthusiastically adopted the pathway. Engagement with local departments for education, and meeting regional radiology to implement change was well received. Three month audits before and after path- way implementation have shown increases of 20% in SDEC (same day emergency care) from 30 to 50%, a 40% increase in uptake of the best supportive care clinic, and a moderate improvement in the quality of referrals to the neurosurgery service (Performance score is now always included in referrals). Despite clear guidance in the pathway, there has been no reduction in the number of times an individual patient is referred or advice requested. CONCLUSION An emergency brain tumour presentation pathway can improve care in a region, but requires regional support, enthusiasm, and teamwork. Measuring pathway implementation success is challenging, but greatly increases the validity of the process.