News
One Stop Transplant/Dermatology Clinic
Central Manchester and Manchester Children’s University Hospitals NHS Trust
Sheila Russell, Advanced Nurse Practitioner and Dr John Lear, Consultant Dermatologist (Central Manchester and Manchester Children’s University Hospitals NHS Trust).
According to NICE Guidelines on the management of skin malignancies (2006), organ transplant recipients are at high risk of developing nonmelanoma skin cancers, due to their long-term immunosuppression therapy. Although skin surveillance already existed as part of the Annual Transplant Review system, the Trust identified a need to reduce the delays between the detection and treatment of suspicious lesions common in organ transplant recipients.
The weekly One Stop Transplant/Dermatology Clinic is run by a renal trained Advanced Nurse Practitioner (ANP), serving around 700 transplant patients. At the clinic, the ANP performs skin surveillance for, and provides advice to, around 15 patients per session. Patients who present with a suspicious lesion or other dermatology problem are seen by the Dermatologist. The Dermatology staff expedite treatment or investigation immediately (e.g. lesion biopsy or excision, cryotherapy, surgical listing for excision or biopsy, prescriptions, etc.).
The One-Stop Transplant/Dermatology Clinic increases the efficiency and effectiveness of the patient pathway and, by referring only those patients with problems to the dermatologist, ensures that dermatology clinic time is used efficiently. Additionally, the clinic is more efficient for the patient as they see a Consultant Dermatologist on the same day, if they have a skin problem.
An audit performed on the first 404 patients to attend this clinic demonstrated that 53 per cent of these patients were seen by a Dermatologist following skin surveillance. Of these, 6 per cent required no treatment, 28 per cent required a prescription, 11 per cent required a surgical excision, 11 per cent required a biopsy and 14 per cent received advice from the Dermatologist. Of the 89 patients who required a surgical excision or biopsy, 26 patients
had a malignant lesion treated and 20 patients had a premalignant lesion treated (still awaiting histology on 10 patients). This data shows that at least 10 per cent of transplant patients attending the clinic had a malignancy or pre-malignancy identified and treated in a timely and effective manner.
This clinic is unique in the UK, due to the collaboration between the two departments, in line with NICE Guidelines recommendations. Although NICE estimated the running costs of such a clinic at £17,480 p.a., this clinic has not required extra funding but runs on the additional input of all the individuals involved.
Image: Sheila Russell, Advanced Nurse Practitioner (Central Manchester and Manchester Children's University Hospitals NHS Trust) and Sir David Henshaw (Chair, NHS North West)