THE NECK STEP - AN ADVANCED CLINICAL PRACTITIONER LED NECK LUMP SERVICE
By Kate Carpenter, Gloucestershire Royal Hospital NHS Foundation Trust
Although we have a well-established Rapid OnSite Evaluation (ROSE) clinic as part of the twice weekly Neck Lump Clinic (NLC), we have found that a number of patients attending for this 2 week-wait (2ww) cancer clinic were returning for a targeted repeat FNA following an inadequate result from a sample taken in the radiology department. An audit on inadequate numbers from patients undergoing an FNA in the radiology department revealed a significant number of repeat FNA’s.
To reduce waiting lists for FNA of the head and neck I am investigating the need to establish a dedicated clinic to review all inadequate samples. This would consist of a small team of advanced clinical practitioners, freeing up radiologist/ENT consultant time. Previous studies have demonstrated sonographer competency in performing FNA(1,2) showing how extended practice into these areas is achievable.
Following discussion with involved stakeholders, it is hoped that this clinic will achieve the goal of reducing waiting lists, reducing pressure on cancer clinics and reducing patient anxiety with quicker, more accurate follow up.
The auditing of cases has helped to highlight areas that can be adapted to ensure advanced practice can evolve to create a new patient centred service. The new development of roles in this way aims to not only improve patient pathways but inspire productive and efficient working(3). A further audit will be performed in 6 months to assess for improvements in waiting lists.
This highlights how advanced practice with a multidisciplinary team approach working together can make real differences to patient pathways. Adapting to develop practice is considered essential for the change in population health needs(3).
References:
1. Dave R, Roberts S, Bekker J, Brennan Pa. Utilisation Of Specialist Sonographers For Head And Neck Ultrasound Fine-Needle Aspiration Cytology Can Help Shorten Waiting Lists And Improve Efficiency Of The Service. British Journal Of Oral And Maxillofacial Surgery. 2023 Jan 1;61(1):111-2.
2. Kirkpatrick C. Ultrasound Head And Neck Services. Rad Mag. 2019;45:9-10.
3. England Nh.Multi-Professional Framework For Advanced Clinical Practice In England. London: Health Education England. 2017. [On- Line] www.hee.nhs.uk/sites/default/files/ documents/multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf (hee.nhs.uk)