Quality statement 1: Integrated reporting

Quality statement

People with haematological cancer have an integrated report produced by a specialist integrated haematological malignancy diagnostic service (SIHMDS) that is shared with the haemato-oncology multidisciplinary team (MDT).

Rationale

An integrated diagnostic report containing all the information relevant to managing a person's condition is important to reduce duplication and avoid any contradictions that may arise when investigations are carried out in separate laboratories. Prompt sharing of integrated reports with the haemato-oncology MDT is vital for making decisions about management and will aid communication and co-working. However, when there is urgent clinical need, SIHMDS should release provisional laboratory reports before the integrated report is produced.

Quality measures

Structure

Evidence of local arrangements to ensure that people with haematological cancer have an integrated report produced by a SIHMDS, containing all clinical information relevant to management, that is shared with the haemato-oncology MDT.

Data source: Local data collection.

Process

a) Proportion of people with haematological cancer who have an integrated report produced by a SIHMDS.

Numerator – the number in the denominator who have an integrated report produced by a SIHMDS.

Denominator – the number of people with haematological cancer.

Data source: Local data collection.

b) Number of integrated reports produced by a SIHMDS that are shared with the haemato-oncology MDT.

Numerator – the number in the denominator that are shared with the haemato-oncology MDT.

Denominator – the number of SIHMDS integrated reports.

Data source: Local data collection.

Outcome

Discontinuation of treatment.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (specialist regional centres) ensure that organisations and departments take responsibility for establishing appropriate management structures that oversee laboratory processes and the quality of diagnostic reporting, and audit the production of SIHMDS-validated integrated reports for people with haematological cancers and the sharing of these with the haemato-oncology MDT.

Healthcare professionals (such as the SIHMDS director and the SIHMDS haematopathologist) are responsible for reporting standards and overseeing the production of the integrated reports that include all the diagnostic information relevant to managing haematological cancers. These reports are shared with the haemato-oncology MDT. The haematopathologist establishes the order in which the different results are included in the report and presented to the MDT, and can explain the report.

Commissioners (such as clinical commissioning groups) ensure that they commission services in which SIHMDS produce validated integrated reports for people with haematological cancers and share them with the relevant haemato-oncology MDT.

People with blood cancer have all of their test results and other information about their diagnosis included in a single report that is shared with their specialist team.

Source guidance

Haematological cancers: improving outcomes (2016) NICE guideline NG47, recommendations 1.1.2 and 1.1.3

Definitions of terms used in this quality statement

Integrated report

A single IT system-generated report summarising all elements of laboratory diagnosis for a specific patient episode, based on available results for haematological cytology, histopathology, immunophenotyping by flow cytometry, cytogenetics, fluorescence in situ hybridisation (FISH) and molecular genetics, in accordance with the current WHO diagnostic classification. A process for validating the report, including double-reporting, and internal audit and cross-checking of results, is recommended before final authorisation.

[Adapted from NICE's guideline on haematological cancers, addendum and recommendations 1.1.3, 1.1.4, 1.1.8 and 1.1.9]

Haemato-oncology MDT

Each haemato-oncology MDT should include sufficient core members for the following people to be present in person or remotely (for example, via video conferencing) at every meeting:

  • Haemato-oncologists (either haematologists or some medical oncologists): at least two who specialise in each tumour type being discussed at that meeting (for example, leukaemia or lymphoma) and at least one from each hospital site contributing to the MDT.

  • Haematopathologist: at least one haematopathologist from the SIHMDS should be present to provide the diagnostic information.

  • Nurses: at least one clinical nurse specialist, also ward sisters from hospitals that provide high‑intensity chemotherapy.

  • Palliative care specialist: at least one palliative care specialist (doctor or nurse) who liaises with specialists from other sites. If, because of staff shortages or location, a palliative care specialist cannot regularly attend MDT meetings, the MDT should be able to demonstrate that it reviews patients regularly with such a specialist.

  • Support staff: staff to organise team meetings and provide secretarial support.

Teams established to manage people with lymphoma should include the following additional core members, who should be fully and regularly involved in MDT discussions:

  • Clinical oncologist: at least one.

  • Radiologist: at least one, who liaises with radiologists at other sites.

Teams responsible for managing people with myeloma should include at least one radiologist who liaises with radiologists at other sites and is fully and regularly involved in MDT discussions. Teams that care for people with myeloma should have rapid access to oncologists for palliative radiotherapy, although it is not necessary for clinical oncologists to regularly attend team meetings.

[Adapted from NICE's guideline on haematological cancers, recommendations 1.3.9, 1.3.10 and 1.3.11]