Clinical tracer Breast cancer Head Neck & Breast Surgery

No planed coordination Breast cancer tracer Good reputation Over crowded Hi tech No planed coordination All around

Breast cancer tracer

Breast cancer tracer Strategy to fix problems Center Breast Research Center Administration of admission and day surgery

Breast cancer tracer Strategy to fix problems

Breast cancer tracer Strategy to fix problems

Breast cancer tracer Strategy to fix problems Circle of Tracer Circle of Coordination Circle of KPI Circle of CQI

Breast cancer tracer Process Risk identification Project for risk correction Tools or instruments Identify Providers & Evaluators KPI Meeting & Feed back (CQI)

Breast cancer tracer กิจกรรม

Breast cancer tracer 101 OPD Ward 101 OR OPD Ward 101 OR Ward Ward Explain variety of treatment 100% ความสมบูรณ์และถูกต้อง consent pre op. evaluation Delay surgery cause by medical condition Psycho-social-patient anxiety improvement pre-op advise >10% Pts. Identification 100% correct side, site Sentinel node identification rate Identified > 90% Operative wound infection Wound infection < 1% D/C planning 1% นัดผิดวัน OPD Ward 101 OR OPD Ward 101 OR Ward Ward Ward OR OR OR OR IC Ward 101 Ward 101 OPD

Breast cancer tracer Advice treatment Risk Miscommunication to pts Activities Explain variety of treatment Consent form Instructions Instruction for patients Action response unit KPI Questionnaire at ward 100% complete consent at waiting room, reported / 6 months Evaluation unit OPD 101 Ward OR

Breast cancer tracer Advice treatment 100 % มี consent form 100% (7/7) 90% complete consent form Data 17-30 Sep 2007

Breast cancer tracer Pre-operative preparation Risk Delayed surgery due to medical condition & drug Activities pre op. evaluation & consult med. CPG Instructions pre op check list patients information for pre-op preparing Action response unit KPI Delay surgery cause by medical condition Evaluation unit OPD 101 Ward OR

อัตราการงด/เลื่อนผ่าตัด ผู้ป่วย CA. Breast ร้อยละ 13.2 11.4 10.1 4.8 4.2 ไตรมาส

Breast cancer tracer Patients identification Risk Pts. Identification: person, drug, site Miscommunication Activities advice & inform time out Instructions time out form Action response unit KPI 100% correct side, site 100% correct operation 100% complete time out form Evaluation unit OPD Ward OR OR

Breast cancer tracer Patients identification 100% correct side, site, 100% correct operation 100 % Completeness of time out form Incomplete ~ 60% Data 17-30 Sep 2007

ร้อยละของความสมบูรณ์ในการบันทึกแบบระบุตัวผู้ป่วยในช่วง time out ของสาขาศีรษะ คอและเต้านม เดือน

ร้อยละความสมบูรณ์ของการบันทึกการตรวจสอบการระบุตัวผู้ป่วย ของสาขาศีรษะ คอและเต้านม ( สค.50 ) ไตรมาส

Breast cancer tracer Psycho-social-patient anxiety Risk Psycho-social-patient anxiety Activities โครงการลดความวิตกกังวลและส่งเสริมภาพลักษณ์ Instructions Action response unit KPI improvement pre-op advise >60% of cases Evaluation unit Ward Ward

Breast cancer tracer Psycho-social-patient anxiety Anxiety score at ward at admission and pre discharge decrease > 60% of all breast cancer patients decrease 66% Data 17-30 Sep 2007

Breast cancer tracer Sentinel node Risk Miss sentinel node (disease specific) Activities Sentinel lymph node biopsy Instructions Sentinel lymph node form Action response unit KPI > 90% sln indentified Evaluation unit OR OR

อุบัติการณ์ไม่พบ Sentinel node ร้อยละ ไตรมาส

Breast cancer tracer operative complication Risk Operative complication: infection, bleeding, re-op Activities Standard OR precaution Instructions IC form Action response unit KPI 0% within 24 hr. re-op < 5% wound infection Evaluation unit OR IC OR

Breast cancer tracer operative complication Rate of surgical site infection (q 1 month) <5% 5.9% (1*/17) *skin flap necrosis Data 17-30 Sep 2007

Breast cancer tracer Inappropriate D/C planning Risk Inappropriate D/C planning Activities Education, appointment system Instructions Documentation of discharge planning (date of D/C, condition on D/C, activity at home, diet, exercise, wound care, limitation etc. Action response unit KPI < 10% Loss of post-op F/U 1st visit < 10% of shoulder stiffness at 1st visit (เทียบ 2 ข้าง) 0% readmission within a week after discharge Evaluation unit Ward 101 OPD

Breast cancer tracer operative complication < 10% Loss of post-op F/U 1st visit 0% < 10% of shoulder stiffness at 1st visit (เทียบ 2 ข้าง) Data collected at สยม 101 < 2% readmission in 28 days after discharge due to surgical site infection Data 17-30 Sep 2007

Breast cancer tracer General excellent KPI % of breast conserve % of reconstruction % of non-palpable % of DCIS % of preserve axilla by SLN % of arm morbidity