Southern Melbourne Integrated Cancer Service 823 867 Centre Road East Bentleigh P.O. Box 72 East Bentleigh Vic 3165 Tel: (03) 9928 8584 Fax: (03) 9928 8624 Service Mapping Report Background and Purpose One of the roles of the Southern Melbourne Integrated Cancer Service (SMICS) is to map cancer services provided to adults by Alfred Health, Peninsula Health and Southern Health for 10 tumour streams. The purpose of this report is to: provide quantitative and qualitative data regarding current cancer services that will be used by the SMICS Tumour Groups and SMICS Governance Groups to plan service improvements; provide baseline data that can be used to evaluate SMICS outcomes; and assist to identify gaps and opportunities for improving cancer service coordination. Report Details This report provides a summary of services provided by: Tumour Stream: Site: Health Service: Genito-Urinary MMC Moorabbin Southern Health Data Collection Period: Jan April 2009 Date of Report: April 2009 This report may need to be read in conjunction with tumour stream reports for other sites. Health Service ( ) Southern Health Monash Medical Centre - Clayton Monash Medical Centre - Moorabbin Dandenong Hospital Casey Hospital _ _ A joint initiative of Alfred Health, Cabrini Health, Peninsula Health & Southern Health Connecting cancer care, driving best practice and improving patient outcomes
Cancer Services Data: Quantitative SMICS / Genito-Urinary Tumour Stream Throughput SMICS / Genito-Urinary Tumour Stream Catchment Areas 2005/08 2500 2000 1500 1000 500 0 Alfred Health Peninsula Health Southern Health Cabrini Health Patients Separations 13% 2% 1% 1% 15% 13% 4% 4% 18% 18% 3% 8% Bayside Cardenia Casey Frankston Glen Eira Greater Dandenong Kingston Monash Mornington Peninsula Port Phillip Stonnington Other Southern Health / Genito-Urinary Tumour Stream Throughput Southern Health / Genito-Urinary Tumour Stream Catchment Areas 2005/08 1200 1000 800 600 400 200 0 Patients Separations 8% 5% 19% 8% 2% 8% 6% 10% Bayside Cardenia Casey Frankston Glen Eira Greater Dandenong Kingston Monash Moorabbin Clayton Dandenong Casey Kingston 10% 10% 7% 7% Mornington Peninsula Port Phillip Stonnington Other 2.
Cancer Services Data: Qualitative 1. General Services Available Onsite Service Onsite Notes or comments Service Onsite Notes or comments Cancer Support Nurses Palliative Care Consultancy service available Breast Care Nurses Pain Service Chemotherapy Pathology - Anatomical Clinical Trials Coordination Pathology - Biochemistry Day Surgery Pathology - Haematology Blood Bank work Dental Services Available at MMC Clayton Pathology - Genetics Sent out Diagnostic Imaging - General Service provided by MIA, private provider Pathology - Microbiology Emergency pathology only Diagnostic Imaging - CT Service provided by MIA, private provider Pathology - Synoptic Reporting Limited synoptic reporting Diagnostic Imaging - MRI Available at MMC Clayton It is anticipated the MIA will be providing in an off site location in the near future. Pastoral Care -Chaplain Diagnostic Imaging - PET Service provided by MIA Pharmacy Diagnostic Imaging Nuclear Med Service provided by MIA Psychology Available at MMC Clayton Dietetics Psycho- Oncology Available at MMC Clayton Emergency Department Located at MMC Clayton Psychiatry Available at MMC Clayton Family Cancer Clinic at MMC Moorabbin Genetic Counselling and at Clayton Physiotherapy GP Liaison Units Service provided at MMC Clayton Pre-admission Clinic Immunotherapy Prosthetics & Orthotics Aides & Equipment Program Interpreting Services Interpreting Services can be organised from MMC Clayton Service provided by Peter MacCallum Cancer Centre at MMC Moorabbin Intensive Care Unit HDU Only - patients requiring ICU sent to MMC Clayton Rehabilitation Physician Lymphoedema Service Speech Pathology Short Stay Unit Available at MMC Clayton Occupational Therapy Social Worker Outpatient Clinics Support Groups Look good Feel Better, Living with Cancer Some patients receive inpatient palliative Palliative Care Beds care on Ward 2 ( no dedicated beds) 3.
2. Overview of Treatment and Care Critical Point 1 Community Level Initial Diagnosis & Referral Patient Journey The patient recognises symptoms or receives an abnormal screening result (if applicable) and sees the General Practitioner (GP). Private Consultant: The patient is referred by their GP to a private urologist. Diagnosis is determined and public patients are referred to the Urology Outpatient Clinic or have their names directly placed on the waiting list for surgery. Outpatient Clinic (MMC Moorabbin): The patient is referred by their GP or private Urologist to the public Urology Outpatient Clinic (Friday AM) located at MMC Moorabbin and attended by the urologist registrar resident fellow and urology liaison nurse. If required, the patient ise referred to Peter MacCallum Cancer Centre (PMCC) at MMC Moorabbin for a second opinion from a radiation oncologist. Supporting Structures & Processes The GP typically requests a PSA test and where an abnormality is detected, the patient is referred to a specialist. If a referral is received with incomplete testing / patient information, a proforma letter is sent to the patient s GP to ensure appropriate information and diagnostic tests results are provided to the clinic. Determine Treatment Program Surgery The patient attends the Urology Outpatient Clinic, which is a mixed clinic, and treatment options are discussed. Where surgery is required, the patient is sent a letter from the bookings office informing them of the date for their surgery. The patient attends the preadmission clinic located at MMC Moorabbin in Clinic 1C on Thursday afternoons. Some patients now have surgery at Casey Hospital. They attend the Pre-admission clinic there on a Wednesday. Urology Multidisciplinary Team meeting The Urology Multidisciplinary Team meeting is held weekly and is attended by: the urologists, registrar, resident, fellows, radiation oncologist and registrar (PMMC), radiologist, pathologist, Ward 3 nurse unit manager, urology liaison nurse, and urology theatre nurse. There is currently no medical oncologist at this meeting. The purpose of this meeting is to discuss and determine patient treatment pathways. Urology patients who are currently receiving treatment are also discussed. Notes are made in the patient s record, based on the discussion held at the meeting. Referrals are made at this meeting and any referrals to PMCC are faxed. Discussion of suitability for a clinical trial is also discussed at this 1 Ministerial Taskforce for Cancer (Draft June 2005), Critical points of Patient Management Framework 4.
Critical Point 1 Implement Treatment Program Patient Journey The patient attends the PMCC Urology Outpatient Clinic (Wednesday AM / PM and Friday AM) and is seen by the radiation oncologist and nurse (where required) to determine radiotherapy treatment. Any relevant clinical trials available are discussed with the patient at a suitable time. The patient attends the public Outpatient Clinic (Monday AM) to discuss chemotherapy treatment options with the Medical Oncologist. Any relevant clinical trials available are discussed with the patient. Surgery The patient attends Preadmission Clinic at Moorabbin prior to surgery to assess their fitness for surgery. Radical prostatectomy patients attend an appointment with a physiotherapist prior to surgery to undergo a pre-operative functional assessment. Following surgery, the patient is admitted to Ward 3 at Moorabbin for recovery. The patient attends an initial consultation with the radiation oncologist prior to the commencement of treatment. The patient attends PMCC Moorabbin for radiotherapy. If patients become unwell during treatment they are admitted to Ward 2 at MMC Moorabbin. Supporting Structures & Processes meeting, which allows the research team to identify patients for recruitment to clinical trials. This meeting precedes the urology clinic. Outpatient Clinic (MMC Moorabbin) The urology liaison nurse contacts patients requiring surgery, to provide any necessary literature and address any queries. A letter is dictated to the GP from the outpatient clinic informing them of the patient s treatment plan. Protocols There is a Trial of Void protocol in place which assists with streamlining care. Treatment protocols are in place. PMCC database is maintained. Letters regarding treatment are provided to the patient s GP Letters regarding treatment are sent to the patient s GP. Surgery: The Ward 3 Weekly Ward Meeting is attended by the nurse unit manager, ward nursing staff, resident, physiotherapist, occupational therapist, social work, dietitian, and Royal District Nursing Service Liaison Nurse. The patient progress and discharge planning is discussed. Referral decisions for post-acute support services are made at this meeting. The Weekly Ward Round is undertaken by: the urologists, registrar, fellow and the urology liaison nurse prior to the Urology Multidisciplinary Team Meeting. A discharge summary is sent to the patient s GP. PMCC Radiotherapy Treatment Protocols are utilised. Quality improvement projects including patient satisfaction surveys are undertaken. Audit mechanisms are in place to inform practice. 5.
Critical Point 1 Follow-Up Patient Journey Urology patients are reviewed weekly at a nurse-led clinic where the radiotherapy nurse meets with the patient. The patient is be reviewed by the Radiation Oncologist at this clinic if required. The patient is referred to a dietitian and / or social worker during treatment if required. Following treatment, the patient is referred back to the referring Urology service or Urologist. The patient attends the Chemotherapy Day Unit at MMC Moorabbin for chemotherapy. On the first day of treatment, the patient is seen by the medical oncology registrar or resident. The patient also meets with nursing staff and an initial patient needs assessment is completed. During treatment, patients are seen by the medical oncology registrar or resident for each cycle of their chemotherapy treatment. Patients undergo regular assessment by the nursing staff during treatment and if issues are identified, referrals are made to appropriate support staff. When a patient becomes unwell during treatment, they are admitted to Ward 2. Clinical Support and Other Services During all stages of treatment, patients are referred to the urology liaison nurse, physiotherapist, occupational therapist, speech pathologist, social worker, dietitian, psychologist, genetic counselling, the Palliative Care Consult Service or palliative care inpatient facility McCulloch House. Following discharge from treatment, patients are referred to the Royal District Nursing Service, Post Acute Care, Local Government Services, Victorian Cancer Council Service, and Rehabilitation In the Home as required Surgery Post-Op Review Clinic The patient attends the Post-operative Outpatient Review Clinic 3-4 weeks following surgery and is seen by the urology resident/ or registrar and urology liaison nurse if required. Where required, the patient attends a follow-up outpatient appointment with the continence physiotherapist. Supporting Structures & Processes Clinical trials are available and are discussed with the patient at a suitable time. Near completion of treatment, a letter is sent to the patient s GP, and the referring urologist is copied in. Chemotherapy Treatment Protocols are utilised. Guidelines have been provided to nursing staff to assist with identifing patients who require referral to a Psychologist. Chemotherapy nursing staff must undertake additional training to qualify for their role. On completion of treatment, a letter is sent to the patient s GP. Clinical Support and Other Services Psychosocial Support During the patient journey, clinicians undertake an informal assessment of psychosocial needs and facilitate referrals to social work and / or psychology. There are no formal supportive care screening tools in use by clinicians. Surgery / / Patient follow-up is coordinated amongst clinicians involved in long term care ie; the patient s GP, urologist and radiation oncologist. Follow-up for patients on a clinical trial is determined by the trial guidelines / protocols. 6.
Critical Point 1 Patient Journey Urology Outpatient Clinic (MMC Moorabbin) The patient attends the Urology Outpatient Clinic for follow-up appointments where further treatment is discussed. Follow-up by the urologist is ongoing. Supporting Structures & Processes The patient attends follow-up appointments at the PMCC Radiotherapy Urology Outpatient Clinic with the radiation oncologist and Nurse (where required). Radiation oncology follow-up tends to be ongoing. Patient follow up with the medical oncologist is carried out at the Outpatient Clinic. Patient follow up with the medical oncologist is carried out at the Outpatient Clinic. Determine & Implement Treatment Program for Recurrence Surgery / / If the patient has disease recurrence it is detected by either their GP or at the follow-up appointments with the urology surgeon, medical oncologist or radiation oncologist. The GP will refer the patient to one of the three specialists and the patient enters the system as they did at the beginning of their journey. Patients with disease recurrence are presented at the Genitourinary MDT for further discussion regarding their treatment. Please see MDT above. 7.
Summary of issues, comments and improvements Issues Issues 2005 Issues 2009 Improvement s Limited access to psychology services. Inefficiency associated with PMCC maintaining patient health records separate to Southern Health Patient transportation to treatment appointments It was noted that due to the greater needs of radical prostatectomy patients, these patients often occupied most of the support staff time. MRI is required at Moorabbin A psycho-sexual counselling service is needed Improvements to Service Office Use Only Version 1.0 Author: HD Date: June 23 2009 Reviewer: JC File Path C:\Documents and Settings\364398\Local Settings\Temporary Internet Files\OLK31\GU Southern Health_ MMCM HD 20090618 v1.0.doc 8.