Driving quality improvements in UK lung cancer care - spotlight on transport and reducing turnaround times for molecular diagnostics


One of the key recommendations of the UKLCC’s Driving Quality Improvements in UK Lung Cancer Report is the importance of maintaining a broad view of services. Looking beyond medical and surgical services to any element within the pathway where quality can be improved - or where time or resources can be freed up - is vital.

As a result, in this next blog in our driving quality improvement series, we asked Dr Louise Medley, Consultant Medical Oncologist from Torbay & South Devon NHS Trust, how making simple changes has had a big impact on molecular diagnostics turnaround times locally.

In the Torbay & South Devon NHS Trust, most lung cancer services are provided on site, but patients must travel to Exeter for EBUS and to Plymouth for video-assisted thoracoscopic surgery and thoracic surgery.  This means that some patients have tissue samples at three different locations which can make full molecular testing more difficult - and lengthy. 

“To improve the current process, a pathway navigator evaluated the molecular diagnosis pathway at each stage, pinpointing elements that were within the control of Torbay NHS Trust. This thorough analysis led to the discovery of two primary opportunities for enhancement. 

“The first was the implementation of reflex testing, which was achieved through collaboration with the histopathology team, especially the histopathology secretaries. This streamlining, through pathologist-lead initiation of biomarker tests, without the need for formal request from an oncologist, succeeded in reducing the sample processing time by a full two days.

“The next action was to look at the way in which samples reached the Genomic Laboratory Hub in Bristol. At that point, specimens were dispatched for analysis via the Royal Mail’s tracked delivery service, resulting in an average turnaround time of four days

“Upon further investigation into alternative delivery methods utilised by the Trust, our team identified that a van designated for HPV specimen transport, funded by Southmead Laboratory in Bristol, was already making daily trips from Cornwall to Bristol. This van was responsible for gathering cervical HPV samples from each hospital along the route for subsequent analysis.

“By changing from the Royal Mail tracked delivery to an existing local transport service the turnaround time was reduced from the original four days to as little as up to one day. 

“The result of these two, relatively straightforward, interventions, has been a reduction in sample turnaround time of a total of five days. To ensure equity of delivery of tissue to facilitate personalised treatment, now other sites in the Southwest have also been encouraged to use the same transport service. 

“Our experience has shown that making small changes can make a big difference in reducing molecular diagnostics turnaround times and getting lung cancer patients onto the right treatments more quickly – thus resulting in better outcomes.”

To submit your examples of best practice which are driving quality improvements in your area, please contact: bestpractice@uklcc.org.uk