Quality in Cancer Surgery Dr. Craig McFadyen VP Cancer Services, Grand River Hospital Regional VP (Waterloo-Wellington), Cancer Care Ontario Medical Director Surgical Oncology, Grand River Regional Cancer Center Director Waterloo-Wellington Breast Assessment Unit

What is Quality ? Patient – Surgical treatment as soon as possible Surgeon – 30 day mortality and morbidity Pathologist – Well oriented intact tissue Medical/Radiation Oncologist – Concise path report, clear margins, healthy patient

Quality Right thing, the right way, at the right time, every time.

Quality in Surgery How do we measure it? What can we measure? Do these mean anything? How do we fix deficiencies?

Access Wait Times

Wait Times, a Primer

Access W 1 = Referral to consultation W 2 = Consultation to treatment

Wait Times W 2 – Consultation – Investigations Direct Due diligence – Wait time from decision to to treat until surgery

But what about the wait time that really matters to the patient? The total time from symptom to treatment Diagnostic Assessment Units – Skin – Breast – Lung

Waterloo Wellington Breast Assessment Unit

Standards in Treatment

CCO, the Program for Evidenced Based Care and Surgical Standards

Colorectal Cancer Standards Preop evaluation Margins Lymph node retrieval Rectal Cancer

Colorectal Cancer Standards Preop evaluation Margins Lymph node retrieval Rectal Cancer

Colorectal Cancer Standards Preop evaluation Margins Lymph node retrieval Rectal Cancer

Colorectal Cancer Standards Preop evaluation Margins Lymph node retrieval Rectal Cancer – TME – Neoadjuvant treatment

Standards- Institutions The volume - quality relationship

Institutional Standards

Thoracic Surgery – St Mary's Hepatic/Biliary and Pancreatic – Grand River

Standards Pathology Reporting Synoptic Reporting

Standards Care Multidisciplinary Case Conferences

Data and Feedback Wait times Rectal Cancer MCC’s

Data and Feedback Wait times Rectal Cancer MCC’s

Data and Feedback Wait times Rectal Cancer MCC’s

Future Clinical guidelines for – Prostate Cancer – Breast Cancer (Sentinel Lymph node biopsy) – Gastric Cancer – Melanoma

Questions