dr. erwig pinter qkb-qualität im krankenhaus beratungsgesellschaft mbh 1 oncological centers &...
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Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 1
Oncological Centers &OnkoZert-Certification Scheme
Deepening Topics
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 2
1. Basics about OnkoZert 2. Oncological Centers3. Benefit of an oncological center4. Requirements regarding Tumour Boards5. Areas for Improvements regarding Tumor Boards
Example OnkoZert Certification: Topics
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 3
1. Basics about OnkoZert
Topic
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 4
What‘s about OnkoZert? Independent facility in Neu-Ulm/Germany Developed the certification system of the German
Cancer association (DKG) for organ cancer centers and oncological centers
Certification on the basis of the medical requirements regarding the treatment of oncologial patients
OnkoZert
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 5
Structure of oncologial treatment centers
3-Stages-model of the oncological treatment structure
Organ Cancer Center
Oncological Center
CCC = Comprehensive Cancer Center
CCC
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Interdisciplinary center: Separate legal personality
4 protagonists center (heads and coordinator) Main treatment partners/key treaters Other cooperation partners Private practices and specialists
Point of intersection: Tumor board
Central target: Consistent same quality regardless where the patient is
transferred to the center
Combi-model OnkoZert
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 7
Combi-model OnkoZert
KTQ-certification
OnkoZert-Certification
QM-System verification
ISO-Certification
• Breast Center• Abdominal Cancer Center
• Lung Cancer CenterFacilitesClinical
pathways
Main treatment partners
Seperate network structure and independent QM system:
ISO-Auditor for Systematic QM in Facilities as well as for QM on center level
OnkoZert-Auditors for medico-scientific requirements
• Prostatic Cancer Center• Skin Tumour Center• Gynecological Cancer Center
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 8
Breast Cancer Center Abdominal Cancer Center
Prostatic Cancer Center
Main cooperation partner
Main cooperation partner
Treatment Care providers
Operating Surgeon Gyn. Oncologist Radiologist Pathologist Internal Oncologist Radio-oncologist Nuklear Medicine
Visceral Surgeon Gastroenterologist Radio-oncologist Internal Oncologist Pathologist Radiologist
Treatment Care providers I Urologist (diagnostic
+operative) Radio-oncologist
Treatment Care providers II Urologist or Internal Oncologist
(chemotherapy) Urologist (diagnostic) Radiologist Pathologist Nuklear Medicine
Combi-model OnkoZert
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Informationand
organisation in center
Tumour Board:Recommendation
on therapy
ReleaseDiagnosis at specialist level
Posttherapeutic reevaluation of the patients treatment success:Informations on treatment progress,therapeutic changes, abortion
of treatment
General practicioner diagnoses:
Cancer?
Ssurgical treatment
Chemotherapeutics
radiooncologiy
Palliative care
Supportive care
Example: Key-Process of the abdominal center
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 10
OnkoZert-Certification system: For interdisciplinary cancer centers Oncological Center with modules and oncological
entities Summary of data in elicitation sheet Fulfilment of requirements in elicitation sheet
necessaryfor certification
Development and further development by interdisciplinary certification committees of the German Cancer association
OnkoZert-Requirements
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Documentation of the oncological treatment Definition of uniform and understandable organ-
specific requirements, key-figures and quality indicators by the German Cancer association, e.g. Primary case Operations Complication
Precondition to measure an increase in the treatments quality
Key figures / Quality indicators
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Documentation of the oncological patient treatment Key figures base on the actual S3 guidelines or
guideline recommendations
Evidence based Medicine:guideline implementations have to be verified by the clinics in the daily treatment regimes during the certification process
Key figures / Quality indicators
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Key- and Part Processes: Oncological patient treatment
Process organisation of an Center
Registra-
tionAdmis-sion
Diagnos-tic
Therapy
Release /Transfe
r
After treatme
nt
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Intersections
Intersections of the key-process: Oncological patient treatment
Registra-
tionAdmis-sion
Diagnos-tic
Therapy
Release /Transfe
r
After treatme
nt
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 15
Target: Evaluation and staging of different tumour entities in a common interdisciplinary weekly conference on the basis of first diagnostic results
Tumor Boards are the core structure for the requested interdisciplinary cooperation and treatment approach
The discussion in TB follows established fixed rules Individual special Tumour Boards for special tumour
entities are possible
Tumour Boards
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Recommendations of the interdisciplinary team must be based on the evidence based medicine and the guidelines or regulations of the medical-scientific associations
Recommendations shold take reference to the guidelines. They shall not reformulate these new Workings out however of the local clinical
diagnostic and treatment procedures (SOPs) along the guidelines are required (Transfer of guidelines into the daily actual clinical treatment)
Tumour Boards
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Recommendations in regard to further diagnostic, therapy and After-treatment procedures of individual patients
Planning of the further treatment of certain tumour patients or patients with recidives in the interdisciplinary team
Establishment and publication of the internal SOPs guidelines (SOPs) for the most important tumour diseases
Tasks of the Tumour Boards
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 18
Procedures to be regulated for the implementation of a Tumour Board Cycle Participants Patient presentation Preparation Procedure of the performance of aTumour Board Tasks after finishing a Tumour Board:
Information and execution of the recommendations
Requiremants regarding the TB implementation
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2. Oncological Center
Topic
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Center for the evaluation and treatment of numeroues tumour enties
Higher grade of specialisation: even the expertise for very rare diseases is focused in such a center
Precondition for the first OC-certification: Integration of at least 2 organ cancer centers and of modules (brain, head, mouth etc.)
Recertification (after 3 years):Integration of at least 3 organ cancer centers
Impact of an Oncological Center
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 21
Structure of an OC
Organ centersBreast centerAbdominal cancer centerLung cancer center
Further Cancer- Entities centersGyn. Cancer CenterCenter for neuroendocrinal tumours
ModulesHead-Throat -CenterNeuro-oncologyPancreas
Clinics: General and Visceral Surgery, Gynecology and Obstetrics, ENT, Oral and maxillofacial surgery, Internal Medicine: all Departments, Thoracic surgery, endovascular surgery, Neuro-surgery
Cooperation-partnersPsychooncologyStudy assistenceNursesPathologyRadiologyRadio-onocologyHematologyOncology etc.
Board/ Steering Committee, Center-coordination, Secretariate
Oncological Cancer Center
External Cooperation Partners
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Clear targetting Set-up, organisational structure, personal of the OC Steering Committee Cooperation partners internal and external Operational and decision making procedures Core competencies and Tumour Boards Documentation of follow up of patients Quality Assurance Cost- and finance structure Action plans Public relations
Rules of Order and development of the OC
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3. Benefits from the Oncological Center
Topic
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Improved communication
Interdisciplinarity
Use of synergies
Continuous, standardized, transparent processesHigh therapeutic standards, prevention of failures
Technical and professional exchange
Oncological Center facilitates
OC impact and benefit to clinics
Facilitation of Clinical Research
Registra-tion
Admission
Diagnostic Therapy Release/
TransferAfter
treatment
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 25
OC uses synergies in a region:
OC impact and benefit for clinics
General practicioners
Center for histopathology
Tumour register
Self-help groups
Hospices
Physiotherapeutics
Ambulant nurses
Social servicesClerical services
Specialists and Consultants
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 26
Board and Steering committee regulates and synchronices the cooperation with the involved organ cancer centers Central coordination of the cooperation Central organisation of tumour boards
Increase of patient orientation Benefit for the Centers: Systematic, positive influence of the synergies with
the individual organ-centers and treatment structures
OC-impact and benefit for centers
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 27
Treatment with highest quality standard
Patients with tumour diseases need holistic, interdisciplinary and continuous treatment.An Oncological Center ensures for:
… also in rare and complex diseases
Inclusion of the patient
Continuity of holistic and comprehensive treatment and ICF
OC-impact and benefit for patients
Frictionless outpatient and stationary treatment
Interdisciplinary diagnosis and therapy
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 28
Patients treatment in OC
Tumour Boardrecommendations Monitoring
After treatment
Stem cell-/ bone marrow stem cell donator
and receiver
hematologic patients
onkologicpatients
oncologic patients
Cooperation partner of OC
Clinic Hematology and Onkologie
Patientmanagement
OC
Patient
Patient
Surgical Treatment
RadiooncologyRelease into patients home, reha o.ä.
Oncologic Center
Other therapies
Conservative treatment
Chemotherapeutics
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 29
4. Requirements for Tumor Boards according to OnkoZert
Topic
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 30
Cycle: Performance at least 1 x weekly Participants (competence level: senior consultants)
Relevant diagnostic, surgical and chemotherpeutic expertise (organ-specific)
Radio-oncology Hematology and Oncology Pathology Radiology
Cycle and participants of Tumour Boards
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 31
Following disciplines/professionals have to be adequately included into the Tumour Boards:
Pharmacy Nurses Surgery Psychooncology Orthopetics special pain treatment Neuro-surgery Study
coordination Neurology Palliative Medicine
Demand-actuated Participants
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 32
Participation of cooperation partners in Tumour Boards:
If different cooperation partners from same discipline work in the Tumor Board service, then the presence of one representative of the discipline is enough
Condition for that: a regular information procedure is implemented (e.g. via quality circles)
Independently thereof each cooperation partner has to participate at least in 30 % of the Tumour Boards in a year
Special regulations
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Written summary of the patients data Distribution of the summary to the participants Select from the patients panel suitable study-
patients Communication with the transfering practitioners:
Admissioners are entitled to participate in the Tumour Boards, when their patients are evaluated
They are entitled to present the clinical status and their clinical data of their patients in the Tumour Board
Preparation
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 34
All tumour patients data are to be presented in a formal procedure and sequence
Organ-specific requirements Centers Moduls Main focuses
Exemptions must be reasoned All patients with recidives and metastases
Presentation of Patient data
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 35
Video conference Under special conditions possible
(if special OnkoZert-requirements are metfor equipment status and performance)
Video conference system must be demostrated online in the certification audit
The requirements of OnkoZert must be satisfied precisely e.g. visibility quality, evaluation possibility, speech quality, operation of system, compensation concept in malfunction
Performance
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Demonstration Image material Availability of patient related images (pathology
and radiology) Suitable technical equipment for the presentation
and demonstration of the images (computerized presentation)
Performance
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 37
Mandatorily required is at least once a participation in the Tumour Boards of the following functions/ professionals: Assistence personal (MTA, TRA,…) from the
functions radiology, nuclear-medicine, radio-oncology
Social Service, Psychooncology, Pharmacy Specially oncology-trained nurses at least 2 for
a treatment unit Refreshment at least all three years
Advanced education
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 38
Plannings of treatment/recommendations of the Tumour Boards are binding
Deviations from the original therapy planning and guidelines must be reasoned, documented and evaluated
Adequate measures have to be taken, that deviations occur only in reasonable cinical situations
Informed consent of the patient about the recommendations of the Tumour Board
Therapy changes or abortion of the herapy according to the will of the patient have to be documented
Impact of the results of the Tumour Boards
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 39
The results of the Tumour Board is a written interdisciplinary treatment planning
Becomes part of patients documentation Can be the content of the release letter to the
transfering practitioner Documentation should be generated automatically
from the electronic tumour information system Patient gets a copy of the documentation on
demand
Documentation of the Tumour Board
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 40
5. Some typical areas for improvements
of the performance of a Tumour Board
Topic
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1. Central registration of patients with a minimum lead time
Areas for Improvement
Patient management OC
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 42
2. Check of the patients documentation in OC regarding completeness. Demanding missing informations and results
Areas for Improvement
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3. Distribution of a list with the patients together with the informations and results to the participants in adequate time before the Tumour Board for their preparation
Areas for Improvement
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 44
4. Self-preparation of the participants of the Tumour Board on the basis of the documention and possibly their own clinical knowledge of the patient
Areas for Improvement
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 45
5. Room equipment and sitting order of the participants
Areas for Improvement
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6. Leading of a Tumor Board by a Board member (Clinical Directors) of the Center or his Deputy
Areas for Improvement
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 47
7. Presentation of the patient after request of the head of the TB by a participant with the discipline nearest to the indication 8. Calling upon the patients along the prepared list
9. Concurrent documentation with concurrent control via beamer checking by the participants
Areas for Improvement
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 48
10. Perfect images of highest quality of the pathologists and radiologists
Areas for Improvement
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 49
11. Explanation of the pathological results by the pathologist and radiologist
12. Video conferences
Areas for Improvement
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 50
13. Inclusion of the clinical knowledge about the patient by a presentation of the practicioner specialist if present
Areas for Improvement
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 51
14. Summary documentation of all recommendations of the Tumour Board as well as a separate documentation on the treatment of a single patient. The summary document has to be signed by each participant. The individual patients document is to be signed by the Head of the Tumour Board.
Areas for Improvement
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 52
15. The decision of the Tumour Board regarding the recommendation for a treatment of a patient must be clear, unmistakably and complete and shall constitute the strategic treatment planning.
Areas for Improvement
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 53
16. The individual patient document with the Tumor Board decision shall become part of the patient file. The decision shall also be cited in the transfering letter to the practitioner as the essential treatment target.
Areas for Improvement
Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 54
17. Informed Consent of the patient about the recommendations of the Tumour Board for obtaining his consent to this treatment
Areas for Improvement