How do we ensure quality in cancer surgery? - Spring ACS Cancer Programs Integration Meetings - Shared screen with speaker view
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will we have access to the slides from all of the presentations done today and yesterday?
We will provide links early next week to all of the Zoom sessions.
Thank you! Very helpful
All information on the CoC Operative Standards can be found on this webpage: https://www.facs.org/quality-programs/cancer/coc/standards/2020/operative-standardsThe ACS CSSP synoptic operative reporting templates are available only to specific contacts at CoC sites and can be accessed through the ACS Learning website. Additional information can be found in this Cancer Programs News article: https://www.facs.org/quality-programs/cancer/news/041521/cssp
One concern expressed by surgeons is that synoptic op reports may not hold up to scrutiny in the event of litigation, thoughts?
Thanks for the question Alex!
Yes, that has been voiced and previously has been an issue--starting to recede now due to Provation templated colonoscopy language and also due to EMR templated op reports becoming so common.
Probably the biggest true issue is surgeon memory of the case 3 years later when issue actually comes to litigation and SOR can make remembering difficult for the individual surgeon.
If there is an open-ended field, won't many surgeons just put everything in that field instead of using the form?
The legal questions are great- thank you. It may be possible that litigation will be more focused on narrative op reports in the near future as the literature demonstrates it is inferior to synoptic reports in terms of completeness and accuracy. The best synoptic reports have space for the clinician to add unique information for unique findings or surgical issues for each patient.
Samantha K Hendren
I have been using the synoptic operative report for rectal cancer for years now, but also include a narrative report of what we saw and did. I would feel very uncomfortable omitting that.
@Sam, I agree! At its best, this is communication with our future selves (narrative component) and also information for colleagues (synoptic component).
I concur that a hybrid approach - synoptic and focused narrative - can be a win-win...and may facilitate change management
@Lauren, would be constructed so SOR portion must be completed and would need to not be excessively onerous.
@Arden, that makes sense. I like the mandatory fields. I am a researcher and have heard this complaint on the research side (that often physicians just use the open-ended field) but I do absolutely see the value of additional information.
And time only moves in one direction!
WE have both narrative and discrete fields for our breast surgery OP reports and it has not been a problem, itt is a nice compromise to let the surgeon put specific details to the case
There are also opportunities to learn from the narrative components being used to complement the synoptic report...and expand the synoptic offerings to embrace some/most/all of the elements deemed clinically important communicated in the narrative prose
@Jeff, agree--we cannot fool ourselves that this will be frozen in time!
I have a question about quality in regards to the specimen. Do the Synoptic Operating Reports or Operating Standards address consistently documenting the time a cancer specimen was removed from the body, and clamp times when applicable? Cold ischemic time is an important pre-analytical factor in assessing tissue quality for molecular testing, which influences treatment decisions, clinical trial eligibility and use in research studies. Though cold ischemic time is calculated by the pathology team, it is important to have coordination from surgeons to consistently provide accurate removal and clamp times, and to release cancer specimens to pathology in a timely manner.
I haven't heard us address the Legal comment that if you use a dot phrase/template for op ntoes, that in litigation a lawyer can say
did you really do that or is it your temoplate
How will the data get into NCDB automatically or manually?
Still manual. For a long time likely. But once data elements are recorded discreetly institutions will easily be able to make reports to pull the data they need to submit to NCDB.
Donna Gress, RHIT, CTR
similar to how registrars use pathologist synoptic reports, easy and quick to find what you need and enter it into the abstract
What is the timeline for alpha and beta testing of the synoptic reports and it is supported by all EMR or just EPIC and sender?
Great Q @Sarah! With the existing SORs, alpha testing by our wonderful committee members as they were created.
Will there be review of pathology in conjunction with the synoptic operative reports?
beta testing underway shortly for the existing SORs
lastly, ACS is engaging with EPIC, Allscripts, and CERNER but it may be that local surgeons asking their local EMR providers can engage and persuade them of this need more effectively than if done solely from ACS
The critical data element is the time the specimen was removed from the body. The time elapsed between that moment and fixation, which stops the biological activity, is called cold ischemia time and is a CRITICAL preanalytical factor when it comes to molecular analysis. More important that when you send it off is when it was removed.
Cold ischemia time will be a requirement for pathological reporting for CAP accreditation.
Implementation of synoptic reporting in pathology and wide use and acceptance did take us 10 years and it is definitely a journey!
`Synoptic reporting has been shown definitively to improve quality, especially for critical missing data elements (like the number of lymph nodes identified) that occur in narrative reports.
Donna Gress, RHIT, CTR
Registrars can attest to what Dr Compton said. We would see tumor size, # of nodes, etc missing.3