Mass General Cancer Center’s Post

This year, World Patient Safety Day places a spotlight on the theme of "Improving diagnosis for patient safety". We are delighted that Charlie Smart, Digital Manager, and Julie Green, Lead Immunisation Nurse, will be presenting at the LLR WPSD event to share how PCL collaborated with the Leicester, Leicestershire and Rutland Integrated Care Board, University Hospitals of Leicester and Nottingham University Hospitals to transform the Two Week Wait (2ww) Brain (Cancer Exclusion) pathway. PCL was challenged to offer an end to end, straight to test streamlined pathway that would complete all follow-up actions, onward referrals and keep the patients and GPs informed of the progress of referrals. Three months later, PCL’s Referral Support Service, which includes Clinical Triage, and a direct to test Brain Cancer Exclusion MRI scan was introduced into the pathway. These category 5 MRI slots can only be used by PCL Triagers and the timeline from GP referral to test result back to a PCL Triager is up to 9 days but often much sooner. The transformed 2ww brain pathway provides continuity of care for patients, is compliant with NICE guidance, keeps patients and referrers informed throughout the pathway and sees patients quicker. The number of handover of care points between primary and secondary care that existed in the previous pathway for diagnostics and onward referral have been significantly reduced. The progress of the referral through RSS is recorded in SystmOne as part of the overall patient journey. The previous pathway received an average of 200 referrals a year and diagnosed an average of 4 brain cancer patients a year. 194 referrals were received in the first 10 months of the transformed pathway which diagnosed 31 brain cancer patients. It is felt by the Project Team (incl. Cancer Clinical Leads) that brain cancer patients that were previously being diagnosed through other routes (e.g. incidental diagnostic findings, the Emergency Department and consultant to consultant referrals) are now coming through the 2WW brain pathway. PCL is very proud of Charlie and the RSS Team and the positive impact that our involvement is having within the system and for patients, especially during the difficult wait for a cancer diagnostic result. #wearePCL #patientcarelocally #patientexperience #nhs #patientfeedback #betterforpatients #betterforthesystem #highqualitycommunityhealthcare #healthequity #teamPCL #healthequityforall #innovation #thereisabetterway #transforminghealthcare

This is a really interesting article about how the gap between the incidence of cervical cancer and mortality is getting smaller. 🩺 Any nurses who have cared for patients with cervical cancer know how devastating the diagnosis can be. 🫂 But knowing that things are moving in a more positive direction is good news for everyone in the medical profession. Treatments and diagnoses are evolving all the time. We would love to hear your comments about how nursing is changing with these advancements. 💙

🩺 Despite record-breaking demand, the NHS are exceeding targets and bringing down waiting times. Here's a quick snapshot: ⬇️ ✅ Faster Cancer Diagnosis: For the first time ever, nearly 80% of patients received a cancer diagnosis or all-clear within 4 weeks! ✅ A&E Efficiency Up: Despite record attendances, 74% of patients were seen within 4 hours in A&E departments. ✅ Reduced Waiting Times: Waits for surgery and other treatments are significantly down, with a 68% reduction in those waiting over 65 weeks! ✅ More Tests Delivered: A record number of diagnostic tests were delivered in February, ensuring faster diagnoses. These achievements are a testament to the incredible work of NHS staff. There's still progress to be made, but it's clear the NHS is on the right track! #NHSheroes #healthcare #recovery

For a long time Ontario family physicians were paid incentives for ensuring that preventative care targets were met. That meant there were financial incentives to ensuring that colon cancer, breast cancer, and cervical cancer screening were completed for eligible patients. I am learning that the beauty of any “incentive” or “bonus” is that it can be taken away. So for years what I have assumed is an important part of my income (i.e: preventative care "bonus") that helps fund my practice, has potential to be axed. For years, family physicians have been fairly compensated to complete cancer screening for their rostered patients. Has a family doctor played a role in ensuring you got your appropriate FIT test/colonoscopy? mammogram? pap test? In “advocating” for us, we have these new complexity-based modifiers, and the preventative care “bonus” is gone. Over the years, family physicians have built toolbars in their EMRs to optimize screening, train nurses (at a personal cost to us) to complete counselling and the skills needed for screening (i.e: pap tests), and many get creative in trying to optimize cancer screening (i.e: mass emails, reminders, run pap clinics, etc). By removing the preventative care bonus, it gives us the sense that it is no longer a service you need us to do. If that's true, you have successfully decreased workload for family physicians. Disincentivizing preventative care suggests family physicians can do LESS preventative care/cancer screening and focus on day to day management of my more complex patients instead. On behalf of all patients, I simply ask if our province prepared for the consequences of this? Ontario, are you ready to better support all the cancer screening programs? Do you have capacity to now do cancer screening for all attached and growing # of unattached patients? Are you going to ensure patients are educated on navigating all of the ins and outs of preventative care screening themselves? If receptionists redirect all cancer screening calls to “Health811” will they be prepared to handle the volumes? Are you increasing funding to the OBSP program as we redirect all breast cancer screening inquiries to them? Especially as screening age for breast cancer will now be earlier at 40? We will happily redirect this work - that’s what I get the sense the ministry wants us to do. That’s fine. But you better be prepared to support all the other facilities for what’s coming their way. Increase capacity all other organizations currently doing preventative care. Empower patients who will need to advocate for themselves. If cancer screening rates go down or even worse, cancer rates go up - we should be embarrassed as a province. I'm glad that a fair plan (i.e: having BOTH a preventative care bonus and an acuity modifier) was just out of the question. We family docs are all somewhere between 1-5 straws away from the one that breaks the camel's back. This is one straw for me - it tests my moral compass.

📃Scientific paper: The role of diagnostic cardiac catheterization for children with congenital heart diseases: local experience Abstract: INTRODUCTION: Despite the development of non-invasive tools of investigations for congenital heart diseases (CHDs), still the role of diagnostic cardiac catheterization (DCC) cannot be undermined. The study aimed to analyze the clinical profile of indicated CHDs cases at our center for DCC to evaluate the contribution of DCC in patients’ management plans. MATERIAL AND METHODS: The study checked files of cases performed DCC between 2011 and 2012 at the pediatric catheterization unit of Alexandria University Children’s Hospital by the same operator. Demographic, laboratory and hemodynamic data were collected and analyzed. RESULTS: Files of 61 children were included in the study. They were grouped into: group I (GI) (n = 25) with pulmonary hypertension (PH), and group II (GII) (n = 36) cases with obstructive pulmonary artery diseases. For the PH group, ventricular septal defect (VSD) was the most common (55%), and patients’ outcome plans were based on angiography – operable subgroup GI-A: (84%) (n = 21) and non-operable (16%) GI-B: (4% inoperable, 12% recommended for sildenafil). GI-B cases were significantly older, with higher PVRI and PVRI/SVRI (3.62, 0.68, p = 0.002) compared to GI-A (0.89, 0.23, p = 0.002, respectively). For group II, tetralogy of Fallot (TOF) was predominant (60%) among the disease spectrum, and the McGoon ratio ranged from 0.7 to 3.2 (median: 1.8). Outcome for GII: 63% operable, 25% shunt, 12% stent. Only pulmonary atresia cases showed a signif... Continued on ES/IODE ➡️ https://etcse.fr/9F5U7 ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

FY25 Highlights: The NEW MDC 5 and MDC 17 DRGs Haven’t gotten around to the replay of the FY25 CMS Update session you registered for but were too busy to attend? Not to worry – I’ll review some of the highlights from the CMS updates over the next four weeks. Last week we reviewed the new MCCs, this week? The new MDC 5 and MDC 17 DRG assignments! The new CV (MDC 5) DRG is assigned for concomitant procedures: a left atrial appendage closure with a cardiac ablation. DRG 317 sits at #15 in the MDC 5 surgical hierarchy with a relative weight of 6.18. This combination of procedures is generally performed for patients with medication-resistant atrial fibrillation. *CDI Consideration: Acute pericarditis is one of the complications of catheter ablation for atrial fibrillation. Acute pericarditis is diagnosed in nearly 4% of patients with median onset at post-op day 1. The risk of acute pericarditis is higher with radiofrequency ablation than cryoablation. Symptoms of this complication include chest pain, pericardial rub, and dyspnea. Tachypnea and nonproductive cough may be present along with fever, chills, and general weakness. The patient will be treated with NSAIDS, colchicine, corticosteroids, and pericardiocentesis for tamponade. In MDC 17, the new surgical DRG is assigned for Acute Leukemia with Other OR Procedure. DRG 850 sits at #4 in the Myeloproliferative surgical hierarchy with a relative weight of 9.21. Prior to the creation of this DRG, patients with acute leukemia who underwent a non-major OR procedure were assigned to a medical DRG. This new DRG is a great addition to the surgical options for this patient population. *CDI Consideration: With the addition of DRG 850 in MDC 17, a title change has been applied to the medical DRG 836 triplet. The new title is “Acute Leukemia.” What changed? “without Major OR Procedure” has been deleted from the title. Hi! If you like this content, don’t forget to “Like” and follow…r. Next Week: Presymptomatic T1D #MICROSOFTCDI #CDI #AHIMAAPPROVEDCDITRAINER

Cancer treatment delays have been proven to have a negative impact on patient outcomes. In fact, a study conducted at Queens University showed that individuals whose cancer treatment is delayed by even one month can have a 6 to 13% higher risk of dying – a risk that keeps rising the longer their treatment is delayed. These delays represent a multifaceted problem attributable to patient preference or needs, provider processes or inefficiencies, and systemic factors within healthcare. Due to her extensive clinical knowledge, our Navvisa Certified Oncology Nurse urged her patient to make an appointment with the radiation oncology as soon as possible, rather than waiting for a second CAT scan, which could not be completed for at least 8 weeks. Our nurse was aware that starting treatment quickly is imperative for optimal health outcomes and she knew the physician would be the most appropriate person to weigh the value of a second CAT scan against the risk of treatment delays. While each individual cancer case is unique, research suggests that, had our patient waited the necessary 2 months to have a second CAT scan prior to seeing his oncologist, he risked a potential 26% increase in mortality risk. So, in addition to the cost savings (~$3,000) and time savings realized by the patient in avoiding a second CAT scan, the patient’s improved chances at a positive health outcome were immeasurable. CLICK HERE TO READ MORE: https://lnkd.in/epJEe-8z #cancertreatment #cancertreatmentdelays #employeebenefits #employeehealth #optimalhealthoutcomes #healthoutcomedisparity

Women with worrying lumps can now benefit from faster diagnosis through a new trial using the NHS App. In Somerset, the pilot programme allows 111 online to refer women directly to breast diagnostic clinics, saving time and reducing stress associated with booking GP appointments. This initiative aims to streamline the diagnostic process for cancer patients while freeing up more GP slots. #NHS #BreastCancerAwareness #HealthcareInnovation

Though heart disease patients have a higher need for palliative care than cancer patients (38.5% vs 34%), cardiac patients are referred to PC at a much lower rate, later in their disease journey, and at a lower level of service. This article makes the case for delinking PC from prognosis for heart disease, and even making PC intervention part of 100% of cardiac patients' plan of care due to the impact on symptoms and the increase in longevity. Great read! https://lnkd.in/drBXjPq7

📃Scientific paper: The effect of hospital caseload on perioperative mortality, morbidity and costs in bladder cancer patients undergoing radical cystectomy: results of the German nationwide inpatient data Abstract: Objectives To determine a data-based optimal annual radical cystectomy (RC) hospital volume threshold and evaluate its clinical significance regarding perioperative mortality, complications, length of hospital stay, and hospital revenues. Material and methods We used the German Nationwide inpatient Data, provided by the Research Data Center of the Federal Bureau of Statistics (2005–2020). 95,841 patients undergoing RC were included. Based on ROC analyses, the optimal RC threshold to reduce mortality, ileus, sepsis, transfusion, hospital stay, and costs is 54, 50, 44, 44, 71 and 76 cases/year, respectively. Therefore, we defined an optimal annual hospital threshold of 50 RCs/year, and we also used the threshold of 20 RCs/year proposed by the EAU guidelines to perform multiple patient-level analyses. Results 28,291 (29.5%) patients were operated in low- (< 20 RC/year), 49,616 (51.8%) in intermediate- (20–49 RC/year), and 17,934 (18.7%) in high-volume (≥ 50 RC/year) centers. After adjusting for major risk factors, high-volume centers were associated with lower inpatient mortality (OR 0.72, 95% CI 0.64–0.8, p < 0.001), shorter length of hospital stay (2.7 days, 95% CI 2.4–2.9, p < 0.001) and lower costs (457 Euros, 95% CI 207–707, p < 0.001) compared to low-volume centers. Patients operated in low-volume centers developed more perioperative complications such as transfusion, sepsis, and ileus. Conclusions Centralization of RC not only improves inpatient morbidity and mo... Continued on ES/IODE ➡️ https://etcse.fr/yIS ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.