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Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 1 Oncological Centers & OnkoZert-Certification Scheme Deepening Topics.

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Präsentation zum Thema: "Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 1 Oncological Centers & OnkoZert-Certification Scheme Deepening Topics."—  Präsentation transkript:

1 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 1 Oncological Centers & OnkoZert-Certification Scheme Deepening Topics

2 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 2 1. Basics about OnkoZert 2. Oncological Centers 3. Benefit of an oncological center 4. Requirements regarding Tumour Boards 5. Areas for Improvements regarding Tumor Boards Example OnkoZert Certification: Topics

3 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 3 1. Basics about OnkoZert Topic

4 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 4 What‘s about OnkoZert?  Independent facility in Neu-Ulm/Germany  Developed the certification system of the German Cancer association (DKG) for organ cancer centers and oncological centers  Certification on the basis of the medical requirements regarding the treatment of oncologial patients OnkoZert

5 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 5 Structure of oncologial treatment centers 3-Stages-model of the oncological treatment structure Organ Cancer Center Oncological Center CCC = Comprehensive Cancer Center CCC

6 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 6  Interdisciplinary center:  Separate legal personality  4 protagonists  center (heads and coordinator)  Main treatment partners/key treaters  Other cooperation partners  Private practices and specialists  Point of intersection:  Tumor board  Central target:  Consistent same quality regardless where the patient is transferred to the center Combi-model OnkoZert

7 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 7 Combi-model OnkoZert KTQ- certification OnkoZert-CertificationQM-System verification ISO- Certification Breast Center Abdominal Cancer Center Lung Cancer Center Facilites Clinical pathways Main treatment partners Seperate network structure and independent QM system: ISO-Auditor for Systematic QM in Facilities as well as for QM on center level OnkoZert-Auditors for medico-scientific requirements Prostatic Cancer Center Skin Tumour Center Gynecological Cancer Center

8 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 8 Breast Cancer CenterAbdominal Cancer CenterProstatic Cancer Center Main cooperation partner Treatment Care providers  Operating Surgeon  Gyn. Oncologist  Radiologist  Pathologist  Internal Oncologist  Radio-oncologist  Nuklear Medicine  Visceral Surgeon  Gastroenterologist  Radio-oncologist  Internal Oncologist  Pathologist  Radiologist Treatment Care providers I  Urologist (diagnostic +operative)  Radio-oncologist Treatment Care providers II  Urologist or Internal  Oncologist (chemotherapy)  Urologist (diagnostic)  Radiologist  Pathologist  Nuklear Medicine Combi-model OnkoZert

9 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 9 Example: Key-Process of the abdominal center

10 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 10 OnkoZert-Certification system:  For interdisciplinary cancer centers  Oncological Center with modules and oncological entities  Summary of data in elicitation sheet  Fulfilment of requirements in elicitation sheet necessary for certification  Development and further development by interdisciplinary certification committees of the German Cancer association OnkoZert-Requirements

11 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 11 Documentation of the oncological treatment  Definition of uniform and understandable organ-specific requirements, key-figures and quality indicators by the German Cancer association, e.g.  Primary case  Operations  Complication  Precondition to measure an increase in the treatments quality Key figures / Quality indicators

12 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 12 Documentation of the oncological patient treatment  Key figures base on the actual S3 guidelines or guideline recommendations  Evidence based Medicine: guideline implementations have to be verified by the clinics in the daily treatment regimes during the certification process Key figures / Quality indicators

13 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 13 Key- and Part Processes: Oncological patient treatment Process organisation of an Center Registra- tion Admis- sion Diagnos- tic Therapy Release /Transfer After treatment

14 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 14 Intersections Intersections of the key-process: Oncological patient treatment Registra- tion Admis- sion Diagnos- tic Therapy Release /Transfer After treatment

15 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 15  Target: Evaluation and staging of different tumour entities in a common interdisciplinary weekly conference on the basis of first diagnostic results  Tumor Boards are the core structure for the requested interdisciplinary cooperation and treatment approach  The discussion in TB follows established fixed rules  Individual special Tumour Boards for special tumour entities are possible Tumour Boards

16 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 16  Recommendations of the interdisciplinary team must be based on the evidence based medicine and the guidelines or regulations of the medical-scientific associations  Recommendations shold take reference to the guidelines. They shall not reformulate these new  Workings out however of the local clinical diagnostic and treatment procedures (SOPs) along the guidelines are required (Transfer of guidelines into the daily actual clinical treatment) Tumour Boards

17 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 17  Recommendations in regard to further diagnostic, therapy and After-treatment procedures of individual patients  Planning of the further treatment of certain tumour patients or patients with recidives in the interdisciplinary team  Establishment and publication of the internal SOPs guidelines (SOPs) for the most important tumour diseases Tasks of the Tumour Boards

18 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 18 Procedures to be regulated for the implementation of a Tumour Board  Cycle  Participants  Patient presentation  Preparation  Procedure of the performance of aTumour Board  Tasks after finishing a Tumour Board: Information and execution of the recommendations Requiremants regarding the TB implementation

19 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Oncological Center Topic

20 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 20  Center for the evaluation and treatment of numeroues tumour enties  Higher grade of specialisation: even the expertise for very rare diseases is focused in such a center  Precondition for the first OC-certification: Integration of at least 2 organ cancer centers and of modules (brain, head, mouth etc.)  Recertification (after 3 years): Integration of at least 3 organ cancer centers Impact of an Oncological Center

21 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 21 Structure of an OC Organ centers Breast center Abdominal cancer center Lung cancer center Further Cancer- Entities centers Gyn. Cancer Center Center for neuroendocrinal tumours Modules Head-Throat - Center Neuro- oncology Pancreas Clinics: General and Visceral Surgery, Gynecology and Obstetrics, ENT, Oral and maxillofacial surgery, Internal Medicine: all Departments, Thoracic surgery, endovascular surgery, Neuro-surgery Cooperation- partners Psychooncology Study assistence Nurses Pathology Radiology Radio-onocology Hematology Oncology etc. Board/ Steering Committee, Center-coordination, Secretariate Oncological Cancer Center External Cooperation Partners

22 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 22  Clear targetting  Set-up, organisational structure, personal of the OC  Steering Committee  Cooperation partners internal and external  Operational and decision making procedures  Core competencies and Tumour Boards  Documentation of follow up of patients  Quality Assurance  Cost- and finance structure  Action plans  Public relations Rules of Order and development of the OC

23 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Benefits from the Oncological Center Topic

24 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 24 Improved communication Interdisciplinarity Use of synergies Continuous, standardized, transparent processes High therapeutic standards, prevention of failures Technical and professional exchange Oncological Center facilitates OC impact and benefit to clinics Facilitation of Clinical Research Registra- tion AdmissionDiagnosticTherapy Release/ Transfer After treatment

25 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 25 OC uses synergies in a region: OC impact and benefit for clinics General practicioners Center for histopathology Tumour register Self-help groups Hospices Physiotherapeutics Ambulant nurses Social services Clerical services Specialists and Consultants

26 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 26 Board and Steering committee regulates and synchronices the cooperation with the involved organ cancer centers  Central coordination of the cooperation  Central organisation of tumour boards  Increase of patient orientation  Benefit for the Centers:  Systematic, positive influence of the synergies with the individual organ-centers and treatment structures OC-impact and benefit for centers

27 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 27 Treatment with highest quality standard Patients with tumour diseases need holistic, interdisciplinary and continuous treatment. An Oncological Center ensures for: … also in rare and complex diseases Inclusion of the patient Continuity of holistic and comprehensive treatment and ICF OC-impact and benefit for patients Frictionless outpatient and stationary treatment Interdisciplinary diagnosis and therapy

28 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 28 Patients treatment in OC

29 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Requirements for Tumor Boards according to OnkoZert Topic

30 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 30  Cycle: Performance at least 1 x weekly  Participants (competence level: senior consultants)  Relevant diagnostic, surgical and chemotherpeutic expertise (organ-specific)  Radio-oncology  Hematology and Oncology  Pathology  Radiology Cycle and participants of Tumour Boards

31 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 31 Following disciplines/professionals have to be adequately included into the Tumour Boards:  Pharmacy  Nurses  Surgery  Psychooncology  Orthopetics  special pain treatment  Neuro-surgery  Study coordination  Neurology  Palliative Medicine Demand-actuated Participants

32 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 32  Participation of cooperation partners in Tumour Boards:  If different cooperation partners from same discipline work in the Tumor Board service, then the presence of one representative of the discipline is enough  Condition for that: a regular information procedure is implemented (e.g. via quality circles)  Independently thereof each cooperation partner has to participate at least in 30 % of the Tumour Boards in a year Special regulations

33 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 33  Written summary of the patients data  Distribution of the summary to the participants  Select from the patients panel suitable study-patients  Communication with the transfering practitioners:  Admissioners are entitled to participate in the Tumour Boards, when their patients are evaluated  They are entitled to present the clinical status and their clinical data of their patients in the Tumour Board Preparation

34 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 34  All tumour patients data are to be presented in a formal procedure and sequence  Organ-specific requirements  Centers  Moduls  Main focuses  Exemptions must be reasoned  All patients with recidives and metastases Presentation of Patient data

35 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 35 Video conference  Under special conditions possible (if special OnkoZert-requirements are met for equipment status and performance)  Video conference system must be demostrated online in the certification audit  The requirements of OnkoZert must be satisfied precisely e.g. visibility quality, evaluation possibility, speech quality, operation of system, compensation concept in malfunction Performance

36 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 36 Demonstration Image material  Availability of patient related images (pathology and radiology)  Suitable technical equipment for the presentation and demonstration of the images (computerized presentation) Performance

37 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 37  Mandatorily required is at least once a participation in the Tumour Boards of the following functions/ professionals:  Assistence personal (MTA, TRA,…) from the functions radiology, nuclear-medicine, radio-oncology  Social Service, Psychooncology, Pharmacy  Specially oncology-trained nurses at least 2 for a treatment unit  Refreshment at least all three years Advanced education

38 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 38  Plannings of treatment/recommendations of the Tumour Boards are binding  Deviations from the original therapy planning and guidelines must be reasoned, documented and evaluated  Adequate measures have to be taken, that deviations occur only in reasonable cinical situations  Informed consent of the patient about the recommendations of the Tumour Board  Therapy changes or abortion of the herapy according to the will of the patient have to be documented Impact of the results of the Tumour Boards

39 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 39  The results of the Tumour Board is a written interdisciplinary treatment planning  Becomes part of patients documentation  Can be the content of the release letter to the transfering practitioner  Documentation should be generated automatically from the electronic tumour information system  Patient gets a copy of the documentation on demand Documentation of the Tumour Board

40 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Some typical areas for improvements of the performance of a Tumour Board Topic

41 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Central registration of patients with a minimum lead time Areas for Improvement Patient management OC

42 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Check of the patients documentation in OC regarding completeness. Demanding missing informations and results Areas for Improvement

43 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Distribution of a list with the patients together with the informations and results to the participants in adequate time before the Tumour Board for their preparation Areas for Improvement

44 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Self-preparation of the participants of the Tumour Board on the basis of the documention and possibly their own clinical knowledge of the patient Areas for Improvement

45 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Room equipment and sitting order of the participants Areas for Improvement

46 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Leading of a Tumor Board by a Board member (Clinical Directors) of the Center or his Deputy Areas for Improvement

47 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Presentation of the patient after request of the head of the TB by a participant with the discipline nearest to the indication 8. Calling upon the patients along the prepared list 9. Concurrent documentation with concurrent control via beamer checking by the participants Areas for Improvement

48 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Perfect images of highest quality of the pathologists and radiologists Areas for Improvement

49 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Explanation of the pathological results by the pathologist and radiologist 12. Video conferences Areas for Improvement

50 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Inclusion of the clinical knowledge about the patient by a presentation of the practicioner specialist if present Areas for Improvement

51 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Summary documentation of all recommendations of the Tumour Board as well as a separate documentation on the treatment of a single patient. The summary document has to be signed by each participant. The individual patients document is to be signed by the Head of the Tumour Board. Areas for Improvement

52 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH The decision of the Tumour Board regarding the recommendation for a treatment of a patient must be clear, unmistakably and complete and shall constitute the strategic treatment planning. Areas for Improvement

53 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH The individual patient document with the Tumor Board decision shall become part of the patient file. The decision shall also be cited in the transfering letter to the practitioner as the essential treatment target. Areas for Improvement

54 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Informed Consent of the patient about the recommendations of the Tumour Board for obtaining his consent to this treatment Areas for Improvement


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