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Quality in Cancer Surgery
Dr. Craig McFadyenVP Cancer Services, Grand River Hospital
Regional VP (Waterloo-Wellington), Cancer Care Ontario
Medical Director Surgical Oncology, Grand River Regional Cancer Center
Director Waterloo-Wellington Breast Assessment Unit
What is Quality ?
• Patient– Surgical treatment as soon as possible
• Surgeon– 30 day mortality and morbidity
• Pathologist– Well oriented intact tissue
• Medical/Radiation Oncologist– Concise path report, clear margins, healthy patient
Quality
• Right thing, the right way, at the right time, every time.
Quality in Surgery
• How do we measure it?
• What can we measure?
• Do these mean anything?
• How do we fix deficiencies?
Access
• Wait Times
Wait Times, a Primer
Access
• W1 = Referral to consultation
• W2 = Consultation to treatment
Wait Times
• W2
– Consultation– Investigations• Direct• Due diligence
– Wait time from decision to to treat until surgery
But what about the wait time that really matters to the patient?
• The total time from symptom to treatment
• Diagnostic Assessment Units– Skin– Breast– Lung
Waterloo Wellington Breast Assessment Unit
Standards in Treatment
CCO, the Program for Evidenced Based Care and Surgical Standards
Colorectal Cancer Standards
Colorectal Cancer Standards
Colorectal Cancer Standards
Colorectal Cancer Standards
• Preop evaluation
• Margins
• Lymph node retrieval
• Rectal Cancer– TME– Neoadjuvant treatment
Standards- Institutions
• The volume - quality relationship
Institutional Standards
Institutional Standards
• Thoracic Surgery– St Mary's
• Hepatic/Biliary and Pancreatic– Grand River
Standards Pathology Reporting
• Synoptic Reporting
Standards Care
• Multidisciplinary Case Conferences
Data and Feedback
Data and Feedback
Data and Feedback
• Wait times
• Rectal Cancer
• MCC’s
Future
• Clinical guidelines for– Prostate Cancer– Breast Cancer (Sentinel Lymph node biopsy) – Gastric Cancer– Melanoma
Questions