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