This project improved clinical documentation by providing staff education, updating training materials and providing regular progress reports on the rate of documentation achieved each month.
Aim
To ensure that 50 per cent of patients in St George Cancer Care Centre have staging information recorded and 75 per cent have their patient performance score documented in the electronic clinical support system.
Benefits
- Improves documentation of clinical indicators in cancer patients.
- Improves patient safety through evidence-based diagnosis and treatment.
- Improves treatment efficacy, future care planning and health outcomes.
- Reduces the risk of emergency department admissions.
- Improves the quality and timeliness of medical information available to staff.
- Reduces gaps in clinical indicators and provides an accurate patient history.
- Enhances communication and correspondence between healthcare teams.
- Improves the ability of staff to monitor neutropenia and other toxicities.
Background
Clinical indicators are used by cancer professionals to measure the quality and type of care received by the patient. Examples of indicators in cancer care include patient performance status, treatment protocols, and Tumour, Node and Metastasis (TNM) staging. Doctors use these indicators to develop plans, schedules and treatments for patients.
The NSW Cancer Plan1 outlines priorities including ‘to improve cancer outcomes’ and ‘to strengthen the capacity of the cancer system to deliver high-quality, patient-centred, integrated, multidisciplinary care, with a focus on reducing unwarranted clinical variation’. To support these priorities, the Reporting for Better Cancer Outcomes funding agreement by the Cancer Institute NSW requires all cancer care departments to provide evidence of clinical indicators such as performance status and staging.
Prior to the project, reports drawn from clinical support systems showed low rates of completion for clinical indicators. Many indicators were collected using analogue methods such as letters, free-text surveys and schedule notes, which made it difficult to monitor indicators effectively and identify areas for improvement in the patient’s treatment. It was determined that capturing clinical information using existing electronic systems would improve communication, patient safety and care.
Implementation
- A multidisciplinary team of advanced trainee doctors, information managers, senior nurse managers and senior radiotherapists was established. The team used a Driver Diagram to identify the root causes of the problem and potential solutions. Key areas for improvement included:
- time management in clinics
- clinical guidelines and procedures
- tumour-specific clinical and system knowledge
- use of existing technology and support.
- The flow of clinical information and current procedures through St George Cancer Care Centre was mapped and a new process of documenting clinical indicators before the patient’s consultation was incorporated into the flowchart.
- Information sessions were held for clinical staff, to educate them on how to enter clinical indicators into the system. This ensured all information was entered accurately and consistently across the centre.
- Reminder cards with checklists were developed and posted in clinic rooms, to encourage staff to collect data in a timely manner.
- Information booklets were placed on consultation desks, to provide staff with a quick reference guide and improve the collection of clinical indicators.
- User guides were updated, to help staff better understand how to record clinical indicators in the system.
- Weekly feedback was provided to clinical teams, to enforce the new documentation process and identify gaps in data collection. This involved generating a list of incomplete data items that were then validated and refined, to accurately reflect the case workload of each team. The frequency of new patient lists was then increased to fortnightly.
- Progress reports were generated to identify trends in the number of patients seen and completion rates of clinical indicators. These were reviewed by senior staff, including heads of departments and the Director of Cancer Services, to maintain ongoing stakeholder engagement.
- Staff training documents were updated, including cheat sheets and quick referral booklets, to ensure changes were sustainable over the long term.
- Plans are underway to expand this project to other facilities in SESLHD.
Status
Sustained – The project has been implemented and is sustained in standard business.
Dates
July 2016 – April 2017
Implementation Sites
St George Cancer Care Centre, St George Hospital, SESLHD
Partnerships
Clinical Leadership Program
Evaluation or Results
- Cancer stage information was recorded electronically in 61 per cent of new patients in August 2017, compared to 17 per cent of new patients in September 2016. This surpassed the project target of 50 per cent.
- Patient performance documentation improved to an average of 55 per cent in August 2017, compared to an average of 12 per cent in September 2016.
- An online pilot staff survey conducted in July 2017 showed that staff were satisfied with the improvement in completion rates. They reported that the new process had increased awareness of documentation and provided a better understanding of the process and the most efficient way to collect data before consultations.
Lessons Learnt
- Consistent reinforcement from senior clinicians was required to maintain the high rate of documentation among junior staff.
- There is a planned overhaul of the electronic treatment planning system, which will align clinical documentation more closely to treatment delivery and further improve results.
- Providing progress reports and feedback to the team implementing the project was critical to its success.
References
Cancer Institute NSW. NSW Cancer Plan: A statewide plan for lessening the impact of cancers in NSW. Sydney: Cancer Institute NSW; 2016.
Further Reading
Contact
Name: Shoma Barat
Position: Cancer Information Program Manager
Organisation: St George Cancer Care Centre, St George Hospital, SESLHD
Phone: 0427 061 038 or 9113 4817
Email: Shoma.barat@health.nsw.gov.au
