Cancer Service Without Walls CSWW

1
Cancer Service Without WallsCSWW

• Maree Bransdon
• Clinical Nurse Consultant
• Cancer Service Without Walls
• Western Sydney Area Health Service

2
Background

• site specific specialist cancer nurse
• recent concept in Australia
• improve existing services

3
Getting Started

• Optimising Cancer Management A Cancer Care Model
  for NSW
• NSW Government Action Plan for Health
• Chronic and Complex Care Implementation and
  Coordination Group (CCCICG)
• CSWW

4
Cancer Service Without Walls
Clinical Linkages and Communications
Intervention Model of Care
The Oncology Record
Palliative Care Medical Officers
General Practitioners Community Health
Lanier Dictation System The Electronic Cancer
Record Personal Health record
CNCs Project Officer
5
Cancer Trajectory
Terminal Care (days/weeks)
Recurrence Treatment (months/years)
Primary Treatment (weeks/months)
6
Changing focusInpatient to Outpatient
Ovarian Cancer n 50
Survival days
Inpatient days
Chemo visits
Overall visits
1170 100
18 1.5
36 3
18 1.5
figures are median
7
Case Study

• 1993 - diagnosis, chemotherapy, Tamoxifen
• 1996 - breast recurrence
• 1997 - left mastectomy skin graft
• 1998 - right mastectomy Axillary Node
  Dissection, Arimidex, Taxotere
• 1998 - chest wall recurrence , Xeolda
• 2000 - weekly Taxol

8
Case Study

• 2001 - progression, bone metastases,
  radiotherapy, completed 61 weeks Taxol
• 2002 - disease progression, radiotherapy,
  chemotherapy, palliative care
• 2003 - deceased
• hospital admissions over 10 year period 10

9
Challenges of outpatient care

• resources are stretched
• increasing number of and access to treatment
  options
• Patients are living well with cancer

10
The Cancer Journey Profile
Qual i ty of Li fe
Primary treatment
Terminal
Relapse
Time
11
Cancer Journey

• Navigate with the patient the complexity and
  variance of their disease process and stages
• facilitate access to a wide range of health
  professionals and support agencies
• cancer care is greater than the solutions
  provided by one source

12
Care Co-ordination

• Clinical assessment
• outpatient clinics
• telephone
• crisis intervention

13
Care Co-ordination

• Point of contact
• patients
• carers
• community nurses
• GPs
• social workers
• other specialties

14
In Summary

• Care co-ordination results in reduced
• anxiety for patient and carers
• waiting time for procedural care
• emergency department presentations
• hospitalisations/admissions

15
BUT.

• There are barriers to the success of this model
  of care
• role development
• role boundaries
• role satisfaction
• role sustainability

16
Vulnerable System Syndrome

• No formalised measurement or monitoring of
  process indicators, incidents, patient/staff
  satisfaction etc
• No Performance Management
• Blame. Denial, silence characterise behaviour
  after adverse incident
• No staff development

17
Changing SystemsSystem Defaults
Best
Before
Better
18
Changing CultureHigh Reliability Organisation

• Key Performance Indicators (KPI)
• Performance Agreements
• Root Cause Analysis (RCA)
• Investment in staff - professional and personal
  courses