Assessment of serum calcium in -patients referred for suspected lung cancer: A quality -improvement project to enhance patient safety in clinical practice.

Background: Hypercalcaemia is a serious complication of lung cancer. A quality improvement project (QIP) was designed based on guidance from the American College of Chest Physician and the European Respiratory Society who recommend measuring serum calcium for patients referred with suspected lung cancer.

Method: Seventy-two patients were included in the initial data to ascertain the delay between referral to the lung cancer pathway and obtaining serum calcium levels as part of the initial work-up. New data were then collected after each intervention (including presentations at weekly respiratory multidisciplinary team meetings, posters within clinical areas and a hospital trust screensaver) to evaluate the delay.

Results: Initially, 11.1% (n=8) did not have serum calcium measured at any point; two of which had lung cancer (including one metastatic malignancy). Of those who had serum calcium measured, there was a median delay of 13 days between first suspicion and obtaining serum calcium. After all the interventions were put in place, patients had a median of 7 days' delay (p=0.001).

Conclusion: This QIP design was based on continued feedback to improve the care of patients suspected of lung cancer. Although there was a significant reduction in delays post-intervention, increasing awareness in the community is suggested to maintain these improvements.