Reducing treatment waiting times

Project write up

The Multiple Sclerosis (MS) Specialist Service Team at James Cook University Hospital (JCUH) has agreed that new ways of working is essential to improve service delivery. As a fairly new recruited MS Specialist Nurse it is apparent that treatment delays are of concern. This is due to an increasing number of people being diagnosed with MS, and not enough MS Specialist Nurses to deal with the increasing case load.

The main objective is to ensure all people with MS are reviewed by a member of the team within a reasonable timeframe up on diagnosis in accordance with NICE guidelines, and all patients eligible for a Disease Modifying Treatment (DMT) are treated without delay.

To achieve this a fourth MS Specialist Nurse will be recruited, this will enable the continuation of the current weekly clinics. An additional clinic will run weekly to manage new diagnosis, DMT switch and relapse management.

Following diagnosis from a Consultant Neurologist, the patient will be given the choice to discuss their diagnosis with an MS Specialist Nurse, or they can arrange an appointment at a later date. The MS Nurse will answer any questions they may have and will discuss DMT’s if eligible.

If a treatment is decided, informed consent can be signed and pre-screening can begin at this appointment: this could reduce delays by approximately four weeks.

The current pathway is timely, and because early diagnosis and treatment are linked with better health outcomes in terms of disease progression, it is essential this is condensed.

Current pathway:

The patient is given a diagnosis of MS by a Consultant Neurologist

The MS Specialist Nurse will arrange to see the patient at a later date to discuss their diagnosis and eligibility for DMT’s

If a DMT is chosen, pre-screening can proceed, if the patient is undecided this may add weeks onto treatment initiation

Once a decision is made pre-screening will commence

All second line DMT’s require consent to be signed by the patient and Consultant Neurologist, therefore, another appointment will be arranged, causing further delays

The additional clinic will enable newly diagnosed patients earlier treatment should they wish to start the screening process following diagnosis

This service improvement has been discussed with the Research Team and future audits will encourage the team to set targets that will help develop the service for the future.