1. Improving access through Innovation
Process/System Re-design System Navigation: Cancer Program Access Coordinator (CPAC) & Referral Form
Tina MacDonald, Colleen Reaume, Moyez Jadavji, Ken Schneider, Allan Forse
Windsor Regional Cancer Centre/ Windsor Regional Hospital
Problem
A significant barrier for expediting cancer assessment and treatment is sub optimal prioritizing of acuity of patients afflicted with colorectal disease. Evidence exists that waiting times to cancer treatment may impact on survival and there is little doubt that increased waiting time has major effects on the emotional well being of patients and families facing this disease.
In addition, Windsor and Essex County has a significant shortage of family physicians.
Objective
To promote education as well as the creation of consistent/appropriate tools for assessing and monitoring patient flow for diagnostic / specialist referrals for all patients in the suspected phase for colorectal cancers.
Solution
Creation of a common “fast track” referral form was designed. This form can educate the family physicians on what information is required for a good assessment and this form also provides the specialists with accurate information for prioritization.
Part of this assessment included education to both family physicians and the public as well as a chart audit of all new referrals to WRCC for colorectal cancer.
Results
changes to nurse’s history and physical form to capture “date of initial symptom”
Clearer understanding of the Privatization Act with a template letter created for future project leaders to utilize.
Chart audit demonstrated:
Appreciation from local physicians that the cancer centre was taking an active involvement in the community for decreasing waiting times.
Family physicians each have their own distinct referral pattern.
It is important to understand “how physicians learn” when introducing a new concept.
Colonoscopies are a “territorial” subject between surgeons and GI specialists.
Patients diagnosed with cancer are still very anxious to learn about preventive measures.
Very clear that the local physician’s here are very anxious for clear colorectal screening guidelines to follow.
Conclusions
The retrospective chart audit indicated that a screening clinic would be beneficial for the Windsor area to streamline diagnostic tests. Unfortunately the fast track tool was not utilized in our community therefore we were unable to compare data after its implementation.
A significant benefit was the multidisciplinary team approach used in the development of this pilot project. A Steering Committee was developed and was made up of Radiologists, GI specialists, General Surgeons, and Oncologists. This committee worked collaboratively on processes for our community to improve education for primary care physicians, education suggestions for the public, identifying the need for provincial direction for best practice to working on the high-risk symptoms and processes surrounding “best practice” for assessment for potential colorectal cancers.
Lines of communication have been significantly improved between healthcare professionals as a result of this project. Primary care physicians have been provided with tools to help them as caregivers to care for this population of patients.
Knowledge Transfer
All physicians within Windsor and Essex County have received an education package on colorectal cancer, with a particular focus on the physicians who work at the 25 walk-in-clinics to offers tools and information on appropriate assessments for symptomatic patients.
Lessons Learned
Lesson 1: Patients diagnosed with cancer are still very anxious to learn about preventive measures.
Lesson 2: Recognized the need to change the nurse’s history and physical form to capture “date of initial symptom”
Lesson 3: Recognized the need to be very familiar with the Privatization Act/ Ethics policies
Lesson 4: Other professional colorectal cancer organizations are anxious to work with the cancer centre and CCO
Lesson 5: Confirmation of CCO's original FOBT report - stating the low utilization of this colorectal cancer test
Lesson 6: Concern with number of patients coming into the hospital emergency room with severe colorectal cancer symptoms (ie: anemia, etc).  This percentage matches a recent finding printed within a Toronto newspaper, Summer 2005.