Transcript A Sample Title Master Heading

Stronach Regional Cancer Centre at Southlake
ESAS and MORE
April 27, 2011
STRONACH REGIONAL
CANCER CENTRE
AT SOUTHLAKE
CENTRE RÉGIONAL DE CANCÉROLOGIE
STRONACH À SOUTHLAKE
Objectives
 Refresher on Edmonton Symptom Assessment
System
 Symptom Management Guides
 Measure of success
www.southlakeregional.org/cancer
CCO Identified Issue…
Cancer Patient Symptoms Not Optimally Managed
Inconsistency in cancer symptom management practices across
province
 Clinicians can fail to recognize 50-80% of patient concerns
during consultation
(Ruland et al, J Am Med Inform Assoc, 2010)
Adequate symptom management is not consistently achieved for
cancer patients
(Patrick et al, J Natl Cancer Inst, 2003)
Poor system outcomes
~ 40% visit ED last 2 weeks; dyspnea and pain among most
common chief complaints
~ acute care LOS last 6 months (14 days)
(CSQI, 2010; Barbera et al, J Can Med Assoc, 2010)
www.southlakeregional.org/cancer
OCSMC Targets Improvement in Cancer Patient’s
Physical and Emotional Symptoms
Purpose
To improve the quality and consistency of
patient’s physical and emotional symptom
management across the patient journey
• Earlier identification and communication of symptoms
• Improved symptom management
• Improved collaborative care planning
Approach
Implement and assist in adoption of common
tools: ESAS, PPS, ECOG, symptom
management guides, collaborative care plans
www.southlakeregional.org/cancer
OCSMC Targets Improvement in Cancer
Patient’s Physical and Emotional Symptoms
Purpose
Host and support ISAAC - electronic tool for
ESAS
Establish and monitor improvement aims and
regional targets
Approach
• 90% lung cancer patients screened with ESAS
• 65% all other cancer patients screened with ESAS
(2010/11)
www.southlakeregional.org/cancer
Ontario Cancer Plan 2011-2015
 Strategic priority #4
“Continue to assess and improve the patient experience”
By 2015 every cancer patient in Ontario will receive care in a
timely manner for physical and emotional symptom scores
flagged through symptom screening.
www.southlakeregional.org/cancer
Edmonton Symptom Assessment Scale
www.southlakeregional.org/cancer
Patients Value Computerized Approach
to Symptom Assessment…
www.southlakeregional.org/cancer
Information Captured in ISAAC Has Uses Ranging
from Individual Patient Care to System Planning and
Performance…
www.southlakeregional.org/cancer
Monthly Reports
 Monthly reports show percentage of patients experiencing
specific symptom
 Identification of resources required to meet patients’
symptoms
 Important for new Cancer Centre developing Palliative and
Supportive Care Program
 Future steps
– Monitor effectiveness of symptom management
www.southlakeregional.org/cancer
Q3 2010- 11 SRCC Reports
Percent of Unique Patients Screened at Least Once with ESAS - Quarterly ESAS Indicator
Southlake Regional Health Centre - RCC
100%
Lung Patient Target = 90%
90%
80%
70%
60%
Other Patient Target = 70%
50%
40%
30%
20%
10%
0%
ESAS Lung indicator
ESAS All Other Cancers indicator
www.southlakeregional.org/cancer
Q3 SRCC 2010-11 Report
Percent of Unique Patients Assessed at Least Once with PPS - Quarterly PPS Indicator
Southlake Regional Health Centre - RCC
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
PPS Lung indicator
PPS All Other Cancers indicator
No targets set for PPS as yet
www.southlakeregional.org/cancer
ESAS and PPS Reports
www.southlakeregional.org/cancer
Need to Manage Symptoms
Have consistent approach to Symptoms
Provide Tools to use as Guide
Provide easy access to tools
Knowledge Transfer
www.southlakeregional.org/cancer
Guide Development
 Symptom Management Working Groups
 Literature search
~ conducted by Rebalance Focus Action Group of Canadian
Cancer Control Strategy
~ Additional search within Ontario programs
~ Evidence-based, cancer-specific, clinical practice focus
 Guidelines reviewed using AGREE tool
 ADAPTE process used to endorse or modify elements of the
chosen guideline
www.southlakeregional.org/cancer
The Tools
www.southlakeregional.org/cancer
www.southlakeregional.org/cancer
Making Knowledge Available at Point of Care
iPhone App Near Completion and Will be Available on iTunes
www.southlakeregional.org/cancer
How to Use the Guides
 Save the link to your workstation PC or portable device
www.cancercare.on.ca/toolbox/symptools/
 Select the symptom you are managing
 Decide if you need a quick reference or need to study the topic
more fully
 Select the full guide, pocket version or algorithm
www.southlakeregional.org/cancer
What’s Next?
 How do we know it is working?
– Chart Audit
– Every month 25 charts
– One symptom
– Look for interventions
~ Referrals
~ Further assessments
~ Decrease in symptom scores over time
www.southlakeregional.org/cancer
Summary of Symptom Management Guides
 Variety of tools to help standardize assessment, documentation
and management of the most common cancer related symptoms
 Pain, Dyspnea, Nausea Vomiting and Delirium
 More to come - Anxiety, Depression
 Easily accessible
 Perform Chart Audit to determine effectiveness of Guides and
Care Plans
www.southlakeregional.org/cancer