Helping patients through the RAPID prostate pathway

05 Aug 2019

Wlodek Mulkowski is a pathway coordinator for the award-winning RAPID prostate cancer diagnostic pathway at Epsom and St Helier University Hospitals NHS Trust.

My role of pathway coordinator was introduced by the NHS to help bridge the gap between supporting clinical teams, coordinating and managing appointments and tracking the patient journey and experience. It’s new to many Trusts across west London.

I am working on the Rapid Access to Prostate Imaging and Diagnosis (RAPID) project, which is a straight to test pathway for suspected prostate cancer. Men given an urgent referral by their GP because of a raised prostate specific antigen (PSA) level receive an MRI (magnetic resonance imaging) scan on their first visit to hospital, after which they see a clinician to receive the MRI results.

The high quality MRI scan allows the clinician to either tell the patient he is at low risk of prostate cancer and can be discharged back to the care of his GP, avoiding an unnecessary biopsy, or offer him the next step on the pathway, which is transperineal prostate biopsy, if the MRI is deemed clinically suspicious.

These activities can happen on the same day, so the pathway offers a simplified ‘one stop shop’, which ensures quicker diagnosis.

Previously, I was a dermatology multidisciplinary team (MDT) coordinator, so when I first started working on RAPID, my understanding about prostate cancer was very limited. I knew that I had a significant amount of learning to do and that there was a huge challenge in front of me. The clinical, nursing and cancer management teams were fantastic and helped to develop my knowledge.

My responsibility starts from the point of referral to allow us to organise the most efficient journey for our patients through the RAPID pathway. This includes booking appointments and MRI scans, and ensuring patients are listed for discussion at the MDT meetings. I also ensure the biopsy is booked in a timely fashion and that patients see both the oncologist and surgeon to discuss their treatment plan following the MDT discussion.

I now independently manage patient pathways; I feel that this close management of each patient’s pathway supports the clinical teams in providing a comprehensive and efficient patient-focused prostate cancer service, which has been reflected in positive patient experience.

I am also responsible for clinical data collection. This is a very crucial factor that enables the management and surgical teams to measure how effective the patient pathway is and make any necessary adjustments to continue to improvement the service.

I find my role particularly satisfying when I see how quickly patients can go through the diagnostic process of the pathway. I also enjoy the independence and accountability. For instance if I see a report about a suspicious MRI scan I can bring forward a patient’s follow up appointment or ask one of my clinical colleagues to advise the patient by telephone about the results and then book the patient for biopsy to avoid any delays.

I often contact patients over the phone to arrange the next step in their pathway – offering them an MRI, a follow up appointment or post biopsy appointment. I often receive feedback as to how they feel on the RAPID pathway and how their experience was so far. If they do voice any concerns, it is my responsibility to act on these and put things right if needed. And although it doesn`t happen often, when issues arise I need to ensure that the patients that need treatment the most urgently are prioritised.

It is very exciting to be involved in this project, especially as RAPID involves something that hadn’t been done before and its success has paved the way for other NHS organisations to implement the pathway. I feel very proud that our work is making such a huge difference to the lives of our patients.