Alsuhaibani Roaa Saleh, Alzahrani Hajer, Algwaiz Ghada, Alfarhan Haneen, Alolayan Ashwaq, Abdelhafiz Nafisa, Ali Yosra, Jazieh Abdul Rahman
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
BMJ Open Qual. 2018 Mar 14;7(1):e000168. doi: 10.1136/bmjoq-2017-000168. eCollection 2018.
Tumour board contributes to providing better patient care by using a multidisciplinary team approach. In the efforts of evaluating the performance of the gastrointestinal tumour board at our institution, it was difficult to assess past performance due to lack of proper use of standardised documentation tool. This project aimed at improving adherence to the documentation tool and its recommendations in order to obtain performance measures for the tumour board. A multidisciplinary team and a plan were developed to improve documentation. Four rapid improvement cycles, Plan-Do-Study-Act (PDSA) cycles, were conducted. The first cycle focused on updating the case discussion summary form (CDSF) based on experts' input and previous identified deficiencies to enhance documentation and improve performance. The second PDSA cycle aimed at incorporating the CDSF into the electronic medical records system and assessing its functionality. The third cycle was to orient and train staff on using the form and launching it. The fourth PDSA cycle aimed at assessing the ability to obtain tumour board performance measures. Adherence to completion of the CDSF improved from 82% (baseline) to 94% after the fourth PDSA cycle. Over 104 consecutive cases discussed in the tumour board between January and July 2016 and 76 cases discussed in 2015, results were as follows: adherence to National Comprehensive Cancer Network guidelines in 2016 was observed in 141 (95%) recommendations, while it was observed in 90 (92%) recommendations in 2015. Changes in the management plans were observed in 37 (36%) cases in 2016 and in 6 (8%) cases in 2015. Regarding tumour board recommendations, 87% were done within 3 months of tumour board discussion in 2016, while 69% were done in 2015. Implementing electronic standardised documentation tool improved communication among the team and enabled getting accurate data about performance measures of the tumour board with positive impact on healthcare process and outcomes.
肿瘤委员会通过采用多学科团队方法，有助于提供更好的患者护理。在评估我们机构胃肠道肿瘤委员会的绩效时，由于缺乏对标准化文档工具的正确使用，难以评估过去的绩效。该项目旨在提高对文档工具及其建议的依从性，以便获得肿瘤委员会的绩效指标。为此制定了一个多学科团队和一项改进文档的计划。进行了四个快速改进循环，即计划-执行-研究-行动（PDSA）循环。第一个循环重点是根据专家意见和先前发现的缺陷更新病例讨论总结表（CDSF），以加强文档记录并提高绩效。第二个PDSA循环旨在将CDSF纳入电子病历系统并评估其功能。第三个循环是对工作人员进行使用该表格的培训并启用该表格。第四个PDSA循环旨在评估获取肿瘤委员会绩效指标的能力。在第四个PDSA循环之后，CDSF的填写完成率从82%（基线）提高到了94%。在2016年1月至7月期间肿瘤委员会连续讨论的104例以上病例以及2015年讨论的76例病例中，结果如下：2016年141条（95%）建议符合美国国立综合癌症网络指南，而2015年为90条（92%）。2016年37例（36%）病例的管理计划有变化，2015年为6例（8%）。关于肿瘤委员会的建议，2016年87%在肿瘤委员会讨论后的3个月内完成，而2015年为69%。实施电子标准化文档工具改善了团队之间的沟通，并能够获取有关肿瘤委员会绩效指标的准确数据，对医疗过程和结果产生了积极影响。
