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Q1 2012 MSCC Audit Acute Oncology Measures

Q1 2012 MSCC Audit Acute Oncology Measures. Rob Turner SJIO/YCN Acute Oncology Group June 2012. MSCC audit measures (1). Requirement that MSCC audit delivered 3 (4) measures Duration of suspicion to confirmation MRI Duration of confirmation to therapy start (Total pathway length)

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Q1 2012 MSCC Audit Acute Oncology Measures

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  1. Q1 2012 MSCC AuditAcute Oncology Measures Rob Turner SJIO/YCN Acute Oncology Group June 2012

  2. MSCC audit measures (1) • Requirement that MSCC audit delivered • 3 (4) measures • Duration of suspicion to confirmation MRI • Duration of confirmation to therapy start • (Total pathway length) • Outcomes • Survival post treatment • Function post treatment • 3 months • 2 years

  3. MSCC audit standards • Duration of suspicion to confirmation MRI • MSCC 24 hours, VBM 7 days • Duration of confirmation to therapy • MSCC 24 hours, VBM 7 days • (Total pathway length) • Unclear • MSCC ?24/48 hours, VBM ?7/14 days • Outcomes • Non stipulated • Local data suggests median OS 40-50 days for MSCC • No requirement to collect baseline prognostics or function

  4. Scope • Scope • Restricted to EBRT only • Surgical pathway not examined • Low numbers • Subject to alternate audit method • Surgical pathway subject to same standards

  5. Methods (1) • Data extracted from • CRIS • Mosaiq • Operator assigned categories • CRIS • Whole spine onc MSCC vs GEN • Mosaiq • Palliative spine • MSCC • Pathway VBM • Non-pathway VBM

  6. Methods (2) • Timelines derived from coded events • Operator dependant time stamping • CRIS events • Mosaiq events • Request received • Intervention actioned

  7. Limitations • Subject to error • Coding/assignment errors • Timing

  8. Pathway activity

  9. MRI activity

  10. Time to MRI pathways

  11. Time to RT pathways

  12. RT process times

  13. Total pathway times

  14. Conclusions • Pathway is rapid for MSCC • Access for MRI (90% compliant) • Case selection is excellent judged by MRI NNS 1.7 • Access for RT (75% compliant) • Total pathway length is less good • 47% compliance with 48 hours • May relate to • Communication/handover • Referral and discharge proformas • Coding • Memo to CO medics and MRI staff

  15. Outcomes: survival

  16. Outcomes: function

  17. Outcomes summary • Median os MSCC 82 days • Leeds group (n=23) • 6 (26%) alive at 3 months • 5 (83%) intermediate or good risk for survival • 3 (60%) functionally impaired • 60% ambulant • 1 failure to recover function • 1 limited by pain • 1 ambulant but failed to recover sphincters • 2 (33%) not dose guideline compliant

  18. Action points • Referral and discharge proformas • Improve handover • Application of prognostic tool • Memo to CO medics and MRI staff • Coding accuracy • Expand scope • Include surgical pathway • Include Cancer Unit MRI datasets

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