Patrick J Keating Gynaecology Oncology SMO Wellington Regional Hospital MDM metrics 1106 new referrals 1086 met criteria 2386 discussions Ratio 219 discussions per patient Despite a widening gap between discussions and patient numbers this ratio is good ID: 1040506
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1. Auckland Annual Clinical report Presentation DayPatrick J KeatingGynaecology Oncology SMOWellington Regional Hospital
2. MDM metrics1,106 new referrals (1,086 met criteria)2,386 discussionsRatio 2.19 discussions per patientDespite a widening gap between discussions and patient numbers this ratio is good.Suggests adequate information is available at the MDM90% women discussed within 14 daysDrop in non Gynae Cancer discussions
3. StaffingGyn Onc SMO5 (4.2 FTE)Med Onc 3Rad Onc3Pathologists4Radiologists3Sp Nurses2 + 1MDM coordinators1.6GO Fellow1UK recommendation is 3 x Gyn Onc per million 7 Gyn Onc SMO’sWellington has2.6 Gyn Onc per 1 million
4. Faster Cancer TreatmentMinistry of Health targets73% in 201683% in 201791% in 2018…congratulationsGynae Oncol MDMThe only one functioning 52 weeks of the year
5. Faster Cancer TreatmentPatients are seen the day after the MDM2015 – 3.2%2016 – 27.1%2017 – 49.6%2018 – 53.1%, and 73.1% within one weekScheduling for IDSDOH 31 day target – 70% in 2016, up to 90%
6. Faster Cancer TreatmentCervix cancer are taking longer to get to theatreEUA might contribute.Why EUA?ESGO 2018 guidelinesMandatory initial workup for assessment of pelvic tumor extent and to guide treatment options is pelvic magnetic resonance imaging (MRI) (grade B). Endovaginal/transrectal ultrasound is an option if performed by a properly trained sonographer.Cystoscopy or rectoscopy may be considered to provide a biopsy if suspicious lesions in the urinary bladder or rectum are documented on MRI or ultrasound.
7. Gynaecologic Oncology SurgeriesIncrease in surgical activity by 11%Really?What happened to those cancers before?More Consultant FTE’s…..Proportion of Malignant to Benign/PreMalignant has INCREASEDIs something else going on?
8. Minimal access Surgery69% endometrial cancers treated laparoscopically.In 2017 it was 30%ExcellentESGO Recommendation 4:10 supports thisSign QPIs (2018)Set the bar at 70%LACC trial – we would agree with you!See recent BGCS paper – size of tumour
9. Ovarian Cancer debulkingPrimary surgery, 60% (2017) up to 69%R0 resections 84% (2017) 88%IDS51% R0 resection88% les than 10mm resectionRecurrence surgeryR0 resection achieved 83%
10. At what price?ComplicationsReadmission rate; 2017 – 8.6%2018 – 5.4%Benign gynaecology readmission after TAH – 12%Overall complications rates are comparable.Increase in blood loss/transfusion8.6% to 12.8%...possibly the ovarian surgical extent?
11. Other stuff.Strategy day - visioningResearchInternational presentationsCollaboration – FeMMe trial, EXCISEAuditMMR testing streamlined.
12. What was I looking for...?Staffing and resources Caseload / Case mixWaiting timesMDM performanceRatio of discussions to patientsCore attendanceTreatment detailsEnhanced recovery programmeLOS MIS 1-2 days, open 3-4 daysProportion of primary vs IDS resectionsProportion Laparoscopic surgeriesProportion Sentinel Groin nodes
13. What else was I looking for...?Outcome dataComplications / readmissionsR0 resections (ovarian/fallopian cancer)Long term data and survivalPatient Information – up to dateGenetic testingHGSCMMRRisk reduction – RRSO / HysterectomyGuidelines updateSpecialist Nurse resourceHolistic needs assessmentsResearch & publicationsAudit
14. ColposcopyC-Quip have not set numerical standardsMakes it difficult to bench-markOverall falling numbers of casesPossible effects of HPV vaccination
15. ColposcopyCan the proportions be compared with the proportions within your community?
16. NCSP guidelinesNo referrals under 20 years of agePossibly more a reflection of primary care?Smoking status13% smoke freeNo mention of HIV testingNo mention in NZ guidelines (as far as I can see)UK National guidelines for HIV testingVaginal intraepithelial neoplasiaCervical intraepithelial neoplasia Grade 2 or above
17. Colposcopy accreditation18 colposcopistsSufficient for 64 cases per yearNo mention of the C-QuIP requirements for accreditationHow many of the 18 are up-to-date?For exampleLess than 95% of HSIL have a biopsyDo you have any outliers?Possible audit…?Training in colposcopyHow many have completed?
18. 2016 Royal Preston Hospital Audit data
19. TreatmentsAll are excisionalLLETZ 92.6%Cold knife 4.8%......why?77% LLETZ under local anaesthesiaTarget is 80%This might be worth an audit.
20. Research & TrainingPRINCESS studyEXCISE studySelf sampling studyRegistrar trainingNumbers?