1141 / From pathway to breast cancer unit

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Diagnostics
Patient involvement There is no specified text here
Topic of the reported practice
Patient safety system
Aim and the benefit of the Patient Safety Practice
 
Breast cancer affects more than 45,000 thousand women in Italy each year. The 80% of women who get breast cancer are over 50 years of age. In ASL VCO (173,000 inhabitants) there is an average of about 165 new cases every year. Such clinical records represents the critical mass sufficient to have a Specialist Breast Unit. In Europe Breast Units were established to guarantee multidisciplinary breast clinical pathways, in compliance with the international guidelines which require specialized health professionals. The care of patients affected by breast cancer within a specialist breast unit, which makes use of adequate technologies and takes advantage of trained professionals, guarantees the quality of treatment and of management of the whole clinical pathway. An accurate and early diagnosis of breast cancer offers women better chances of treatment. Effectively it assures a higher oncologic efficacy and improves the recovering of appearance thanks to conservative and reconstructive surgery. The improvement of prognosis and of plastic surgical technics helps the rehabilitation of the patient both from a physical and psychological point of view. This allows women to have an adequate quality of their affective, familiar, social and working life. The support services provided by the Breast Unit, such as psychological, rehabilitative and social assistance, enhance the present diagnostic and therapeutic pathway so that to support the personal autonomy, the maintenance of satisfying social and psychological relationships, the achievement of new lifestyles.
Therefore, the aim of this project is to move from the care pathway to the Breast Unit, ensuring diagnosis in a timely fashion, surgery and chemotherapy.
Description of the Patient Safety Practice
 
In 2012 the Breast Cancer Care Interdisciplinary Group of ASL VCO decided to review the pathway for the establishment of a Breast Unit. The working group shared and wrote the care clinical pathway, completing it with procedures of management and organization and with diagnostic and therapeutic protocols for every single step of the pathway. The Care Interdisciplinary Group (CIG), composed of a surgeon, an anatomic pathologist, a radiologist, a Medical Oncologist, a Radiation Oncologist, Radiographer, Psychiatrist, a Psycho-oncologist, a clinical geneticist, a family physician and three breast care nurse, meets once a week (Multidisciplinary Case Management Meeting). The CIG verifies and assesses collectively each clinical case so that to adopt the most appropriate diagnostic and therapeutic pathway according to the clinical necessities of every single patient. Specifically the CIG manages: • Newly identified cases • Operated cases • Disease relapses • SQTM 4.1 Database Patients commence primary treatment within four weeks from the definitive diagnosis. They are offered clear oral and written information (leaflets) regarding diagnosis and treatment options. There is a specialist palliative care service for patients with advanced breast cancer. In such cases ASL VCO establishes a close working relationship between members of the Breast Unit and the palliative care service to ensure that breakdowns in continuity of care do not occur. A local network for home assistance is present and is highly appreciated by relatives.
The CIG clinical director updates the medical records online completing them with the data collected by single specialists and guarantees a constant communication with the patient and his relatives in accordance with the code of ethics and privacy. All relevant data are collected through specific forms recorded in a database and periodically analyzed and evaluated to assess the need of improvements and/or corrective measures. Clinical Risk Unit, in order to guarantee the safety of patients and staff, investigates adverse events, determines the causes (Root Cause Analysis, Audit, SEA) and develops amending actions to prevent the occurrence of similar events in the future.
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
There is no specified text here
There is no specified text here
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Yes
Specification of implementation in another health care setting(s)
Primary care
Successful implementation's level  of this Patient Safety Practice across settings
Yes, across multiple specialities across different health care settings
Involved health care staff
 
Physicians
Nurses
Health care assistants
Pharmacists
Therapists
Social workers
Dieticians/ Nutritionists
Clinical support
Technical support / technician
Administrative support (secretary, clerk, receptionist etc.)
Environmental support (Housekeeping)
Clinical manager
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Relative(s)
Patient representative(s)
Patient organisation(s)
Point of time in which service user or their reprasentatives' involvement takes place
During the application of the Patient Safety Practice
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
Yes
Short description of the service users' level of involvement
Not known
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/questionnaire.aspx?id=4679
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
Yes
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
Not sufficient human resources available
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Not known
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Margherita Bianchi
Country: ITALY
Organisation: OSPEDALI RIUNITI A.S.L. 14
E-mail: margherita.bianchi@aslvco.it
Phone: There is no specified text here
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