About the project

The Shine 2011 team at Sheffield Teaching Hospitals is systematically identifying optimal models of ambulatory care (care that can be delivered on an outpatient basis) delivery that are appropriate for a range of haematological cancer treatments. They hope to reduce length of inpatient stay, minimise delays in treatment delivery, increase bed capacity, and enhance the patient experience.

A pilot project was carried out in 2008/09 to deliver high-dose chemotherapy and blood stem cell infusion for selected patients with myeloma through the day case facility.

The patients remained as outpatients, residing in a purpose built apartment with a designated carer, until such time that routine drug toxicity dictated hospital admission. The project resulted in an average inpatient length of stay saving of seven days, representing a 33% reduction in the normal inpatient duration.

The team is building on this experience by developing new models of ambulatory care. These will include early discharge and total ambulatory care for those patients in need of allogeneic and autologous transplants, or myelosuppressive chemotherapy for acute leukaemia and lymphoma.

Why this project?

The incidence of cancer is expected to increase by 25% over the next 15 years. Department of Health analysis suggests that the cost of inpatient care will increase by 24% over the same period, unless inpatient length of stay is reduced.

Haematological cancer patients have the highest inpatient bed occupancy of all the tumour groups, despite having an incidence rate of less than 10% of all cancers. Patients with acute leukaemia, lymphoma and myeloma often require intensive chemotherapy and bone marrow transplant that necessitate lengthy inpatient stays.

The majority of patients who receive inpatient chemotherapy for their haematological cancer in Sheffield experience inpatient stays of between 28 and 35 days, due to the myelosuppressive treatment-related side effects from the chemotherapy regimens used. Bone marrow transplant patients also experience similar lengths of stay.

Most NHS cancer resources and models of care delivery are inflexible to increasing demand for modern, intensive haematological treatments. In addition, recent policy initiatives, including the Cancer Reform Strategy, have encouraged the development of service delivery that is closer to patients’ homes, and offering patients greater choice about the environment in which they receive care.