NNHLA Quality Improvement Intervention – Case Studies

In the short film below, Data Liaison Manager, Simon Cairns, from the National Disease Registration Service (NDRS), shares details of how colleagues based at the NDRS successfully collaborated with Bradford Teaching Hospitals NHS Foundation Trust, to effectively enhance their data quality.

Oxford University Hospitals NHS Foundation Trust has been taking practical steps to improve the completeness of lymphoma staging data recorded locally, to support more complete audit submissions over time.

The issues identified locally

Dr Graham Collins, Consultant Haematologist and Lymphoma Lead at Oxford University Hospitals NHS Foundation Trust noted that the trust’s main issue was poor data returns.

A key learning for the team was gaining a clearer understanding of how staging information is captured and transferred in local systems. Dr Collins explained that the team had previously assumed that entering staging data into the trust’s prescribing system (Aria) would feed through to the National Disease Registration Service (NDRS) therefore be reflected in the Audit. The quality improvement work highlighted that staging data needed to be recorded in Infoflex for submission. The team also identified that the MDT coordinator had the most direct access to enter this information into the system.

The team also highlighted a practical challenge: haematological malignancies are complex, and even when staging is mentioned during MDT meetings it is not always easy for the MDT coordinator to record the staging information reliably.

What changed

The Oxford team introduced two process changes to support more consistent recording of staging and related information in Infoflex.

1. Brief review at the end of the MDT meeting for new lymphoma diagnoses

To improve the routine capture of key staging information, Dr Collins introduced a brief meeting at the end of each MDT meeting for new lymphoma diagnoses. As the MDT chair, he now meets with the MDT coordinator to confirm the stage and other relevant information, which are then recorded directly in Infoflex at the time of discussion.

Dr Collins noted that the approach may not capture every patient – for example, when some cases are not brought to the MDT meeting – but emphasised that the change improves the consistency and accuracy of information recorded for those who are discussed.

2. A change to ensure new chronic lymphocytic leukaemia (CLL) patients are logged via the MDT route

The Oxford team found that essentially no staging data was recorded for CLL patients, largely because most CLL patients do not need to be discussed at the MDT meeting as their management is protocolised.

To address this, the CLL specialist nurse now refers every new CLL patient to the MDT meetings. These patients are listed at the end of the agenda as not for discussion, but the referral ensures the work is logged and staging information is recorded. This simple change has helped make the process more consistent while requiring minimal additional MDT time.

Early signs of impact

Dr Collins noted that it will take time to see whether these changes translate into more complete data returns. The trust will be able to assess progress as submissions reflect the new approach.

Practical lessons other trusts may find helpful

Based on Oxford’s experience, practical steps that may support data quality improvements include:

• Confirm which local system needs to hold staging information for NDRS/audit submissions. Trusts are encouraged to contact their local Data Improvement Lead at NDRS if necessary.
• Integrate a short, repeatable step into the MDT routine to confirm and record key information directly in the system used for data submissions.
• Review pathways for patient groups that are not routinely discussed at MDT meetings, ensuring there is a reliable process for capturing essential information consistently.

We will continue to build a small library of case studies and will publish additional case studies in due course; providing further examples to support trusts in their ongoing quality improvement work.

Improving staging data quality through MDT proformas and structured patient tracking

High-quality, complete data is essential for supporting clinical decision-making, enabling effective discussion in MDT meeting, and ensuring accurate national audit submissions. Improving data completeness also helps strengthen oversight of patient pathways, supporting timely diagnosis and treatment and ultimately contributing to better patient outcomes.

Over a one-year period, Barts Health NHS Trust increased the completeness of its Ann Arbor staging data from approximately 30% to over 70%, demonstrating significant progress.

Barts Health NHS Trust has implemented a series of practical changes within its haematology multidisciplinary team (MDT) processes to improve the completeness of key data items such as staging and performance status. These improvements have also supported better tracking of patient pathways and performance against national cancer targets.

Data quality overtime- Ann Arbor staging for Barts Health NHS Trust between 1 October 2022 and 30 September 2025, extracted from NNHLA Quarterly Data Dashboard April 2026 release

Action Taken

1) Introduction of structured MDT (meeting) proformas by haematological disease groups and pathway

A suite of MDT proformas was developed to enhance data capture across different haematological conditions and contexts, including:

• Myeloid and leukaemia
• Myeloma
• Lymphoma
• Inpatient cases
• External referrals

Each proforma includes a designated section highlighting where updates are needed such as performance status, staging, and other key COSD Data items.

This approach has helped the trust to 1) understand patient volume in each group; 2) identify trends and gaps in meeting the 62 days target; 3) improve COSD data completeness.  

2) Embedding data capture aligned with national data submission requirements

The proformas were designed to reflect the data fields required for data submission, helping to ensure that:

• Key information is recorded at the point of clinical discussion
• The data being recorded locally aligns with COSD and other relevant datasets requirement
• Completeness of required data items improves over time

This has supported more reliable and complete data submissions.

3) Weekly MDT review meetings for active patient tracking

A weekly structured review meeting was introduced between the MDT coordinator and MDT consultant. During this session:

• Each patient on the pathway tracking list (PTL) is reviewed
• Outstanding actions (e.g. diagnostics, results) are identified
• Decisions are made on whether patients can be removed from the PTL

This process has improved oversight of patient pathways; supported timely decision-making, and kept patients on the PTL to a minimum.

4) Regular pathway tracking list (PTL) escalation and communication process

Following the MDT review meeting, a PTL escalation process is carried out:

• Key issues (e.g. delayed diagnostics, dates requiring escalation) are identified
• A summary is shared with consultants, highlighting patients nearing pathway breaches
• Consultants provide input on patient management and PTL status

This ensures shared visibility across the clinical team and enables early intervention when any delays are identified.

Impact

The changes introduced at Barts Health NHS Trust have resulted in clear improvements in both data completeness and pathway oversight.

The impacts include:

• Ann Arbor staging completeness increasing from around 30% to over 70% within one year, reflecting a substantial improvement in data capture
• Better transparency of MDT activity across different haematological disease groups
• Enhanced ability to identify trends and areas for improvement
• Improved monitoring of performance against Faster Diagnosis Standard (FDS) and 62-day targets*
• More effective and efficient management of the PTL, helping to reduce backlog and avoid breaches.

The structured use of MDT (meeting) proformas has been particularly valuable in ensuring that key clinical information is consistently recorded at source.

Note: *People with high-grade lymphoma (Burkitt lymphoma (BL), DLBCL (Diffuse Large B-Cell Lymphoma) or high-grade T-cell) receiving SACT, who start SACT within 62 days of referral.

Who has been involved

This work has been delivered through a collaborative multidisciplinary approach, involving:

• MDT coordinators
• MDT clinical leads and consultants
• Cancer services and operational management
• Chemotherapy team representatives
• Wider MDT contributors supporting pathway monitoring and escalation

This collaborative working has been key to embedding the changes into routine practice.

Practical lessons other trusts may find helpful

Based on Barts Health NHS Trust’s experience, the following practical steps may support improvements in staging data completeness and pathway management:

• Introduce structured MDT (meeting) proformas tailored to disease groups and/or pathway to standardise data capture
• Align MDT documentation with COSD and other datasets requirements to support direct use in submissions
• Embed routine MDT review checkpoints to monitor patient progress and outstanding actions
• Establish regular PTL review and escalation processes to maintain oversight and minimise delays
• Promote shared visibility across clinical teams to support early action on patients nearing breaches
• Use MDT-level data to identify trends and inform service improvements.