This study indicates that Whole Disease Model development is feasible and can allow for the economic analysis of most interventions across a disease service within a consistent conceptual and mathematical infrastructure. This disease-level modeling approach may be of particular value in providing an economic basis to support other clinical guidelines.

Colorectal cancer includes cancerous growths in the colon, rectum and appendix and affects around 30 000 people in England each year. Maximizing health benefits for patients with colorectal cancer requires consideration of costs and outcomes across the whole service. In an era of scarce healthcare resources, there is a need to consider not only whether technologies and services may be considered clinically effective, but also whether they are cost-effective, that is, whether they represent value for money for the health service. Through the development of a whole disease model, it is possible to evaluate the cost-effectiveness of a range of options for service development consistently within a common framework. Discrete event simulation has been used to model the complete colorectal cancer patient pathway from patient presentation through to referral and diagnosis, treatment, follow-up, potential recurrence, treatment of metastases and end-of-life care. This simulation model has been used to examine the potential cost-effectiveness of different options for change across the entire colorectal cancer pathway. This paper provides an empirical demonstration of the potential application of modelling entire disease areas to inform clinical policy and resource allocation decision-making.

This study is believed to be the most comprehensive attempt to identify the direct cost of managing bowel cancer services in England. The approach adopted could be useful to assist local decision makers in identifying those aspects of the pathway that are most uncertain in terms of their cost-effectiveness and as a basis to explore the implications of re-allocated resources. Research recommendations include the need for detailed costs on surgical procedures, high-risk patients and the utilization of the methods used in this study across other cancers.

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Due to its rarity, awareness of this condition is important in its prevention and successful management.

An effective surgical handover is imperative to optimise patient care and safety, whilst ensuring progression of clinical management and the delivery of an efficient service. The introduction of full-shift working, as a response to progressive implementation of the European Working Time Directive (EWTD), has placed the spotlight on patient and doctor safety. Effective handover between shifts is vital to protect patient safety and assist doctors with clinical governance. The weekend is a critical point where the transfer of patient care to the ongoing weekend team is efficient, thorough and informative, as this is a point in the patient journey where the patient is the most vulnerable. The weekend team is often not responsible for the management of the patient throughout the week and poor or incomplete information can have disastrous consequences on patient safety. (1,2,3)There is a general consensus and anecdotal evidence that this process is variable, occasionally unsafe or of poor quality, and can be improved. (4,5,6,7,8,9,10,11) However, no standardised format is deemed optimal or available. The aim therefore, was to design and implement a weekend handover proforma, in order to deliver a more efficient and safer system for patient care over the weekend without increasing junior doctor workload. The Weekend Out Of Hours Surgical Handover (WOOSH) form was designed following consultation with medical, nursing and allied health professionals. All staff were instructed how to complete the form, with pre- and post-intervention questionnaires undertaken.The results of the study enforce and advocate the permanent practice of the WOOSH form with 93.33% endorsing the permanent introduction of the form and 100% finding the form useful.

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