Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Organized Diagnostic Assessment Demonstration Projects Grand River Regional Diagnostic Assessment Unit Robinne Hauck, Jennifer Parkins, Mark Berry, Colleen Graham Grand River Regional Cancer Center (GRRCC) Project Summary Program Goals: 1. Timely access for diagnosis and The Thoracic Diagnostic Assessment Unit assessment of patients with suspected at Grand River Regional Cancer Centre lung cancer provides timely access, assessment, 2. Multidisciplinary care by thoracic team diagnosis and follow-up for patients 3. Comprehensive coordinated care by suspected of having lung cancer. nurse navigator to avoid gaps in patient journey Problem 4. Implementation of evidence-based care • Long wait times for CT Scan guidelines for thoracic surgery • Long wait times for referral to respirologist or thoracic surgeon Critical Interventions: • Non-standardized treatment plans • Development of a thoracic disease site • Multiple unmet needs of complex team, led by a Respirologist and Clinical patients Nurse Specialist to review clinical • Uncoordinated care pathway for patients pathways and develop standardized • High morbidity and mortality in Thoracic approach to care surgery patients • Implementation of diagnostic guideline of 2 weeks • Wait time tracking and follow-up Solution • Partnerships with primary care We implemented a thoracic diagnostic physicians to order chest CT at the time assessment unit in a Integrated Cancer of referral and review medical history Program. We secured clinic space within • Bringing thoracic surgeons and the cancer centre and provided the respirologists into joint weekly clinics to necessary supports, including office reduce the time between appointments. supplies and tools needed to provide diagnostic procedures such as Program Impact: thoracentesis. We worked collaboratively • 157 cases seen by DAU with two of the nine respirologists and one • Time from referral to diagnosis reduced of the thoracic surgeons who acted as from 113 days (June 2007) to 69 days champions for this unit. (Sept 2008) A Nurse Navigator (0.6 FTE) was • 57% of cases referred to Thoracic introduced to screen patients; assess MCCs family needs; link patients in to the team; Benefits reported by patients: discuss care plans; and provide Peace of mind, support, compassion and supportive care. understanding Relationship built with primary care Improvement in pain through open referral basis to family Nurse and Surgeon’s attention to physicians to improve accessibility and to questions and easily understood build capacity. answers Top 3 achievements 1. Team commitment and collaboration to ensure patient journey was without gaps 2. Timely access to diagnosis for patients. 3. Role of nurse navigator in the care of patient throughout diagnostic, treatment and follow-up phases Top 3 challenges 1. Recognition of a new clinic in an ICP for patients who did not have an actual diagnosis of cancer. 2. Difficulty gaining commitment for allocated times for diagnostics 3. Surgeon coverage for DAU Next Steps: Conclusions Overall, the patient experience has been well supported by the introduction of the DAU. The nurse navigator is able to follow the patient through all phases of care including diagnosis, treatment, palliation and follow-up. The DAU has provided more timely access to diagnostic procedures. Gaps are avoided by following the processes of care for the patient and their family. • In November 2008 the program secured booked CT guided biopsy slots at two centres in the LHIN • Thoracic DAU to be integrated into Surgical Oncology Program; continuation of weekly clinics • Clinic Nurse role to change to a CNS role, with a focus on individuals with lung cancer and their family within the ICP • Engagement of regional physicians • Thoracic Disease Site Team, with a focus on wait time from CT to diagnosis and Multidisciplinary Cancer Conferences • Open to opportunities for knowledge transfer to other disease site teams in the development of other Diagnostic Assessment Units