Specialist Nurses advancing Lung Nodule management

A dedicated nurse-led service at OUH is setting an example by delivering safe, effective and highly efficient patient-centred care, as evidenced by their consistently excellent performance over the last two years. 

The Lung Nodule service, developed in late 2022, comprises two specialist nurses and an administrator. The team works alongside respiratory physicians and thoracic radiologists to analyse CT images and determine whether patients can be discharged, or need follow-up scans or referrals.

The team recently presented their service template at the British Thoracic Oncology Group (BTOG) Annual Conference 2024 in Belfast and European Respiratory Society (ERS) Conference 2024 in Vienna. They will also present at the British Thoracic Society (BTS) Conference in London.

What are lung nodules?

Nodules are a small growth in the lung that are commonly seen on CT scans. While over 90 percent of lung nodules are harmless, some may develop into small lung cancers. If these are diagnosed early, they can be treated before they spread to other parts of the body – so can potentially save lives.

Separating the cancers from the harmless nodules usually requires review by consultant radiologists and respiratory physicians. Without a dedicated service, this is often done alongside other clinical work which can result in longer times between follow-up appointments and discussions around the outcome of CT scans with patients.

How the service works

The team receives an average of 80 referrals a month via OUH clinicians and GPs. One of the main roles of the nurses upon receiving a referral is to analyse CT images for any solid nodules and determine whether the patient can be discharged, or if they need follow up scans or a referral to the lung cancer team. The nurses discuss complex cases, possible cancers, and growing nodules with the respiratory and radiology consultants and make further action plans as needed.

The service is largely virtual, but there is clinic time twice a week to see patients face-to-face and discuss more complex cases.

Initially having to tackle a six-month backlog – which they cleared within months – the service has been noted for impressive delivery and development, with a service template for other similar centres across the country to use. This will benefit patients and ensure consistency of service, with an improvement in lung cancer detections rates and cost savings.

Specialist Nurses: 'Nodule Navigators'

Nurses Adedamola Falolu and Joanne Yates underwent training by radiologists at OUH to fully comprehend lung nodule management and CT scan interpretation.

An year into the service, the nurses were more formally trained using a web-based training package developed at OUH, Pulmonary Nodules on CT from RAIQC, kindly funded by the Thames Valley Cancer Alliance (TVCA).

Almost a year after they started their training, this pilot programme has shown improvements across the service, with: 

- A reduction in time from CT scanning to letting patients know their results
- A reduction in patients needing follow-up scans
- A projected significant increase in savings for OUH.

The specialist nurses have also: 

- Improved patient safety by coding and monitoring all CT scan reports across the Trust that report a lung nodule
- Created a standardised electronic patient referral pathway within the Trust and from primary care 
- Facilitated smoking cessation advice at point of referral.

Adedamola Falolu, one of the specialist nurses said: "Running the service would not have been possible without the encouragement and dedication of the radiologists who took out time to teach us initially, and the continued support from the respiratory and radiology teams."

Rachel Benamore, Lead Consultant Radiologist for the service said: "I'm extremely proud of the service that we have built with the nodule navigators, who provide safe and effective care for our patients. The service has proved to be immensely helpful in reducing waiting time for patients, which is really important at what can be quite a worrying time for them."

Sarim Ather, CEO at RAIQC and Radiology Digital Lead at OUH, said: "It is great to see the RAIQC platform, which was developed at OUH, positively impacting patient care. 

"Being web-based, the training tool can be accessed from anywhere in the world. We hope to enable more hospitals to follow the nodule navigator model and deliver higher quality care."

Jennifer Graystone, Clinical Director at Thames Valley Cancer Alliance and a consultant at OUH, said: "One of the functions of TVCA is to provide transformation and innovation to cancer services for the people of Thames Valley, and I’m delighted that this initiative has led to the development of this particular specialist service to support diagnosis of pulmonary nodules in our patients." 

Professor Andrew Brent, Chief Medical Officer at OUH, said: "It is important and appreciated that our teams find innovative solutions to make our services efficient and reduce patient waiting times. 

"We are thrilled to see the positive impact of the lung nodule service, and are excited to see further improvements across it."