Clinical tracer Breast cancer

1
Clinical tracerBreast cancer

• Head Neck Breast Surgery

2
Breast cancer tracer
Good reputation
Over crowded
Hi tech
No planed coordination
All around
3
Breast cancer tracer
4
Breast cancer tracerStrategy to fix problems
5
Breast cancer tracerStrategy to fix problems
6
Breast cancer tracerStrategy to fix problems
7
Breast cancer tracerStrategy to fix problems
Circle of Tracer
Circle of Coordination
Circle of KPI
Circle of CQI
8
Breast cancer tracer
Process

1. Risk identification
2. Project for risk correction
3. Tools or instruments
4. Identify Providers Evaluators
5. KPI
6. Meeting Feed back (CQI)

9
Breast cancer tracer
???????
10
Breast cancer tracer
Explain variety of treatment 100 ????????????????????? consent
pre op. evaluation Delay surgery cause by medical condition
Psycho-social-patient anxiety improvement pre-op advise gt10
Pts. Identification 100 correct side, site
Sentinel node identification rate Identified gt 90
Operative wound infection Wound infection lt 1
D/C planning 1 ?????????
OPD
Ward
101
OR
OPD
Ward
101
OR
Ward
Ward
Ward
OR
OR
OR
OR
IC
Ward
101
Ward
101
OPD
11
Breast cancer tracer Advice treatment
Risk Miscommunication to pts
Activities Explain variety of treatment Consent form
Instructions Instruction for patients Consent form
Action response unit
KPI Questionnaire at ward 100 complete consent at waiting room, reported / 6 months
Evaluation unit
OPD
101
Ward
OR
12
(No Transcript)
13
Breast cancer tracer Advice treatment
100 ?? consent form 100 (7/7)
90 complete consent form 100 (7/7)
Data 17-30 Sep 2007
14
Breast cancer tracer Pre-operative preparation
Risk Delayed surgery due to medical condition drug
Activities pre op. evaluation consult med. CPG
Instructions pre op check list patients information for pre-op preparing
Action response unit
KPI Delay surgery cause by medical condition
Evaluation unit
OPD
101
Ward
OR
15
??????????/???????????? ??????? CA. Breast
??????
13.2
11.4
10.1
4.8
4.2
??????
16
Breast cancer tracerPatients identification
Risk Pts. Identification person, drug, site Miscommunication
Activities advice inform time out
Instructions time out form
Action response unit
KPI 100 correct side, site 100 correct operation 100 complete time out form
Evaluation unit
OPD
Ward
OR
OR
17
Breast cancer tracerPatients identification
100 correct side, site, 100 correct operation 100
Completeness of time out form Incomplete 60
Data 17-30 Sep 2007
18
??????????????????????????????????????????????????
???? time out ???????????? ???????????
??????
?????
19
??????????????????????????????????????????????????
?????? ???????????? ??????????? ( ??.50 )
??????
??????
20
Breast cancer tracer Psycho-social-patient
anxiety
Risk Psycho-social-patient anxiety
Activities ??????????????????????????????????????????
Instructions
Action response unit
KPI improvement pre-op advise gt60 of cases
Evaluation unit
Ward
Ward
21
Breast cancer tracer Psycho-social-patient
anxiety
Anxiety score at ward at admission and pre discharge decrease gt 60 of all breast cancer patients decrease 66
Data 17-30 Sep 2007
22
Breast cancer tracerSentinel node
Risk Miss sentinel node (disease specific)
Activities Sentinel lymph node biopsy
Instructions Sentinel lymph node form
Action response unit
KPI gt 90 sln indentified
Evaluation unit
OR
OR
23
???????????????? Sentinel node
??????
??????
24
Breast cancer traceroperative complication
Risk Operative complication infection, bleeding, re-op
Activities Standard OR precaution
Instructions IC form
Action response unit
KPI 0 within 24 hr. re-op lt 5 wound infection
Evaluation unit
OR
IC
OR
25
Breast cancer traceroperative complication
Rate of surgical site infection (q 1 month) lt5 5.9 (1/17) skin flap necrosis
Data 17-30 Sep 2007
26
Breast cancer tracerInappropriate D/C planning
Risk Inappropriate D/C planning
Activities Education, appointment system
Instructions Documentation of discharge planning (date of D/C, condition on D/C, activity at home, diet, exercise, wound care, limitation etc.
Action response unit
KPI lt 10 Loss of post-op F/U 1st visit lt 10 of shoulder stiffness at 1st visit (????? 2 ????) 0 readmission within a week after discharge
Evaluation unit
Ward
101
OPD
27
Breast cancer traceroperative complication
lt 10 Loss of post-op F/U 1st visit 0
lt 10 of shoulder stiffness at 1st visit (????? 2 ????) Data collected at ??? 101
lt 2 readmission in 28 days after discharge due to surgical site infection 0
Data 17-30 Sep 2007
28
Breast cancer tracerGeneral excellent
KPI of breast conserve of reconstruction of non-palpable of DCIS of preserve axilla by SLN of arm morbidity