Staten Island University Hospital Northwell Health ... · Out-pt CONSULTATIONS: Volume remains in a...
Transcript of Staten Island University Hospital Northwell Health ... · Out-pt CONSULTATIONS: Volume remains in a...
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StatenIslandUniversityHospitalNorthwellHealthExecutiveSummary2017
Completed November2018
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TABLEOFCONTENTS
CancerCommitteeMembership 3
CancerCommitteeChairReport 4-7
SurgicalOncologyReport 8-9
PediatricOncologyReport 10-12
RadiationOncologyReport 13-15
RadiologyReport 16-17
HematologicNurseNavigatorReport 18-19
BreastHealthNavigatorReport 20-21
GastrointestinalNurseNavigatorReport 22-23
Head/NeckNavigatorReport 24-25
LungNavigatorReport 26-27
RehabilitationReport 28-31
CancerRegistryReport 32-34
OncologyResearchReport 35-36
UniversityHospice 37-39
CancerEducationandPreventionReport 40-41
CommunityOutreachYearEndSummary 42-48
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2017CancerCommitteeMembershipPatriciaM.Altschuler,BSN,RN,HeadandNeckNavigator
LisaCarolan,RN,MHA,PIManager
NancyCaserta,RN,OCN,BreastHealthNavigator
RaimondaClark,RN,MA,M.ED,AssociateExecutiveDirector,OncologyServices
CynaraCoomer,MD,CancerLiaisonPhysician
ClaudineDeMarco,RN,MSN,GastrointestinalNurseNavigator
FrankForte,MD,Director,PalliativeCareMedicine
KerryGillespie,DirectorComplimentaryMedicine
NoraGoldberg,Manager,OccupationalTherapy
LauraLongo,RN,BSN,NPDirector,PatientCareServices,AmbulatoryOncology
MicheleLotito,HealthInformationManagement
LouiseMadrigal,RN,BSN,OCN,CRC,ManagerClinicalResearch
PaulaMcAvoy,RN,MPS,OCNAdmDirector,UniversityHospiceOncology
AveryMiller,MS,CGC,GeneticCounselor
LaurenMoore,AmericanCancerSociety
LynneOpitz,MD,AssociateChair,Pathology
AntonioPicon,MD,SurgicalOncology
HeatherPolizzi,BSN,RN,HematologicMalignanciesNavigator
DeirdreQuirk,CTR,RHIACancerRegistryCoordinator
MariaRapuzzi,RN,BreastHealthNavigator
CarolynSimone,LCSW,Manager,CommunityEducationandMarketing
TerenigTerjanian,MD,Chairman,CancerCommittee
DeniseTorsney,RN,NurseManager,3B
PennyTroiano,MSW,LCSW,OCW-C,OncologySocialWorker
SarahVaiselbuh,MD,PediatricOncology
JudyValitutto,RN,LungNavigator
PhilipVigneri,DO,Chairman,RadiationOncology3
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TerenigTerjanian,MDChair,CancerCommittee
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CancerCommitteeChairReport
Cancermanagementcontinuestobeoneofthemajortargetsofhealthcarerealities.Itisestimatedthat,thisyearmorethan1,700,000millionpeoplewillbediagnosedwithcancer.Morethan600,00willdiefromthedisease.Inadditiontotheobligationofprovidinghighqualitycancercaretoourcommunity,theCancerCenterduty includesparticipatingincancerresearchtoachievethefinalgoalofacureforeverykindofcancer.Progresshasbeenmadeoverthelastthirtyfiveyearswithanexplosionofnewandeffectivetreatmentsachievingnotonlybettersurvival,butalsoasignificantnumberofcures.
TheCancerCenterwasestablishedin1991inordertorespondtotheneedsoftheStatenIslandcommunity,andtoavoidtheburdenofcommutingtoNewYorkCityfortheircare.Forthatreason,acomprehensivecancercareprogramincludingallaspectsofthemanagementofmalignantdisorderswascreated.AlloftheareasofcancertreatmentsareavailableatStatenIslandUniversityHospitalNorthwellHealth.Surgery,chemotherapy,radiationtherapy,immunotherapy,nutritionalandpsycho-socialservices,patienteducation,cancerscreening,physiotherapy,rehabilitation,palliativecareprogram,hospiceandcommunityoutreach.(Pleaseseeseparatereportsfortheabovementionedprograms).
Alloftheseprovidedthroughacoordinatedmultidisciplinaryapproach,usingthemostupdatedinformationavailable,consistentwithnationalguidelinerecommendationsinadedicatedenvironmentthatuniteshighqualitycareofanacademicandwellrespectedinstitutionwiththecomfort,convenience,personaltouchanddedicationofprivateinstitutionsorpractices.Forallofthesereasons,thecancerprogramwasaccreditedforanotherthreeyearswithcommendationfora3rd timeinarowin2017bytheAmericanCollegeofSurgeonsCommissiononCancer.Thisisanhonorreservedtoonlyabout75institutions outofoverathousand Ourprogramisdueforanothersurvey in2020. Wehopetoachievethesamehighlevelofaccreditationwithcommendation.
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Themultidisciplinaryapproachisattheheartofthecancerprogram.Theintentionisnotonlytreatment,buttodosoinarelaxingenvironmentwithallofthenecessaryancillaryandsubspecialtyservicesavailable,suchasgynecologicandurologiconcologicconsultations andfollowupprovidedonsite,althoughtheCancerCenterhasbeenprincipallythehomeoftheMedicalOncologydivisionsince1991.Thecenterdoesnotdiscriminatebasedoninsurancecoverage.Alloncologicandhematologicpatientsaretreatedwithout distinctionbetween“clinic”and“private”patients.Thenumberofpatientsvisitsatthecenterisover30,000peryear.Atpresent,thereareplanstomovethelocationoftheCancerCenterandexpandittoaccommodatethe increasingnumberofpatientssincethepresentfacilityhasreachednearsaturationlevels.Asexpected,therehavebeenpersonnelchangesattheattendingphysicians’level.Theprogramhiredanewhematologist-oncologistDr.Sokoloff joinedourteaminearly2017.Wearelookingfora7th oncologistfor2018.
FeaturesoftheCancerCenterandprogramincludethefollowing:
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• Extensivechemotherapytreatmentcenterofferingthelatestmodalitieswitha alloftherecentlyavailabledrugsinadditiontothetraditionaltreatmentsunderthesupervisionoftheattendingphysiciansandoncologycertifiednurses.
• FullyequippedRadiationOncologyprogram
• PalliativeCareservicesandaHospiceprogram
• DedicatedservicesforPediatricHematologyandOncologyunderthedirectionofDr.SarahVaiselbuh
• Fourconsultationandtenexaminationroomswithasixteenchairoutpatientchemotherapyunit
• Inpatientoncologyunit
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• On-sitelaboratoryservices
• Dedicatedoncologypharmacy
• CancerInformationLine
• NutritionalServices
• NurseNavigatorprograms
• Geneticcounseling
• SocialServicesprogramtoassistpatientsandfamilieswithfinancialassistanceandcounseling
• Support groupsandpatienteducationprograms
• UptodateradiologicservicesPET-CT,CATscan,MRI,nuclearimaging,digitalmammogramunitinadditiontostandardxrays
• BloodBankunitwithcytophoresisandplasmapheresiscapabilities
• CancerRegistryData
• Hematology-Oncologyresearchprogramwiththeappropriatedesignatedpersonnel
• Academicactivities(lectures,conferences,journalclubs)intheconferencecenter
• ComplementaryMedicineservices
• ACGME-approvedHematology-Oncologyfellowshipprogramhousingamultiheadmicroscope
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AntonioPicon,MDSurgicalOncology
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SurgicalOncologyReport2017
1. Wewillenforcepathologyslidereviewfromoutside institutions foralloncological cases.2. AspertheCommissiononCancermeasure,wewillmonitor thetrendforadequatelymphadenectomy incoloncancerresections.3. Wewillincreasethenumber ofgastrointestinaloncologyandsofttissuetumorcasespresentedatourmedical-surgicalweeklytumorconferencemeetings.4. Wewillcreateamultidisciplinary gastrointestinalconferencethatcanbeusedtodiscussadditionalGIoncology casesoutsideourregulartumor conference.5. SurgicalattendanceatTumorConferencein2017wasover90%.TheCancerCommitteesettherequiredattendancetobe80%.Everyeffortwillbemadetokeepthesurgicalattendanceatthehighestlevel.
Goals20181. IncreasethenumberofSurgicalOncologycasesin2018.2. Toincorporatethenursenavigatorroleintoothersurgical
disciplines.3. Consolidatetheroleofthemultidisciplinary GIconference.4. Increasethenumberofsurgicaloncologycases,prospectiveand
retrospective,presentedattumorconference.
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SarahVaiselbuh,MDChair,PediatricOncologyServices
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TheDivisionofPediatricHematology/Oncologyprovidesclinicalservicesforchildrenwithcancersaswellasbenignblooddisorders.Focusonoutpatientchemotherapy(insteadofhospitalization)isauniquefeatureoftheChildren’sCancerCenteratSIUHthataimsatincreasingthequalityoflifeofbothchildandparentsalike,sincethechildrencanreturnhomeintheeveningtothefamiliarityoftheirownbedroom.
ThePediatricHematology/OncologydivisionhasdevelopedpoliciesandproceduresfullyintegratedwithNorthwellstandardsofcare.Wetrainedmid-levelproviderswhoaretheliaisonbetween inpatientandoutpatientnursingstaff.Theyprovidetrainingprogramsforpediatricnursessotheygainconfidenceintheclinicalmanagementofoncologypatients.Asacorerotationofthepediatric residencyprogram,ourfacultyisdailyinvolvedinmentoringandguidanceofrotatingresidents.ToimpacttheacademicproductivityoftheDepartmentofPediatricsandresidenttraineesatSIUH,Dr.Romanosplaysakeyroleasco-chairoftheresearchandscholarshipcommittee.Dr.Vaiselbuhistheprincipalinvestigator(PI)ofherlaboratoryinbasicscienceinexosomesinleukemiaresearchatFeinsteinInstituteofMedicalResearch.Inaddition,she isthePIonaclinicalphaseIIItrialthatevaluatestheefficiencyofaninvestigationalantibodyinpatientswithsicklecellcrisis.Bothattendingphysicianshavehadmultipleabstractsacceptedforposterand/ororalpresentationsatregionalandnationalmeetingsandareactivelyinvolvedinmentoringjuniorfacultyandhousestaff.
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WeinitiatedProjectS.M.I.L.E.– apainawarenessandcomfortprogramforchildrenofallagesafflictedbydisease.Theresidentsarebeingtrainedinpainawarenessandcomfortkitsarebeingdistributedtohelpdistractchildrenduringpainfulproceduressuchasneedlesticks.Ourdivision isalsohometotheHistioCareprogram– aspecialtyprogramforchildrenandadultsaffectedbyHistiocyticDisorders.WecurrentlyareaparticipatingsiteoftheInternationalRegistryforRareHistiocyticDisorders(IRHDR)andamemberingoodstandingoftheNorthAmericanConsortiumforHistiocytosis.
CancerCommitteesettheacquiredattendanceat80%.ThePediatricHematologyOncologyattendancelevelhasbeenpersistentlyat80%orabove.
Goalsfor2018:
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• Expandtheprimarycarereferralbasebyuseoftheambulatoryelectronichealthrecordconsultationnotestoimproverapidcommunicationwithreferringphysicians
• PatientenrollmentonLCHIVprotocol(internationalprotocolfortreatmentofLangherhansCellHistiocytosis)
• DevelopresearchcollaborationstoenhancepatientenrollmentforclinicalcancertrialsacrossNorthwellHealthCancerServices
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P.Vigneri,DOChair,RadiationMedicineTreatmentServices
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CONSULTATIONS:Volumeremainsinazone,withasmallgaininout-patients.
PARTIALBREASTIRRADIATION(PBI)- GiventheconcernsraisedbyrecurrencesintheTARGITtrial,areviewwasdoneofourcohort. Resultsfoundonerecurrencein98cases(2013-2015). Overall,volumewasconsistent in2017.
PatientstreatedwithIORT- 25PatientstreatedwithSAVIcatheter- 25TotalpatientstreatedwithPBI- 50
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SBRT(FOCUSEDTREATMENT)FORSTAGEILUNGCANCERSBRTformedicallyinoperableStageILungCancercontinuedtogainacceptance.Allpatientswerediscussedatthemultidisciplinarythoracicconference.
RESEARCH: Theintraoperativebrachytherapy(IORT)caseswerereviewedgivenconcernsfromtheTARGITtrialofrecurrencerisk.In90patientstreatedfrom2013-2016therewere2localrecurrences,whichiswellwithinnationalguidelines(5%at5years).
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EricTrenkmann,MDDirector,BreastImagingCenter
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INTRODUCTION: In2017therewereseveraltechnologicadvancesandupgradesintheBreastImagingCenter,aswellasfurtherstaffdevelopment.
TECHNOLOGY: In2017wepurchasedanewultrasoundmachine,anddidsoftwareupgradesonthe2existingunits.Ultrasoundhasbeeninincreaseddemandasasupplementalscreeningforpatientswithdensebreasts.
ENVIRONMENTOFCARE: In2017wecontinuedto improvetheaestheticsoftheBreastCentertohelpimprovethepatientexperience.
CLINICALVOLUMES:TheBreastCenterperformed17,117screeningmammograms,4,811diagnosticmammograms,5,134breastultrasounds,and969interventionalbreastprocedures.244breastcancerdiagnosesweremade,103ofwhichwerescreendetected.
2017AUDITANDBENCHMARKS:RESULT BENCHMARK
CALLBACKRATE11.15%5-12%SCREEN-DETECTEDCANCERRATE5.17/1000>2.5/1000PPV15.27%3-8%PPV332.7%20-40%
GOALSFOR2018:
Installationofour2nd &3rd TomosynthesisMammographyUnitsInstallationofour4th UltrasoundUnitCreatemoreschedulingavailabilityforpatientsneedingsamedayscreeningmammography/sonographyWehavenew,integratedclinicalsystems/applicationswithintheNorthwellHealthservicelineBeginofferingSaturdayappointmentsfordiagnosticimaging
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HematologicMalignanciesPatientNurseNavigator
HeatherPolizzi,BSN,RN
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Nursenavigatorsprovidedirectpatientcareandcomprehensivecoordinationofcareforpatientsandtheirfamilies/caregiverstoeliminatebarrierstotimelycareandfacilitateflowthroughthesystem,increasepatientandprovidersatisfaction,maintainpointofcontactwithprovidersandserveasthefirstpointofcontactforpatientsandfamilies.TheNurseNavigatorassistsincoordinationofmultidisciplinarycarefrominitialscreening,finaldiagnosisandsurvivorship.Navigatorsareresponsibleforeducating,coordinating,facilitating,andparticipatinginallpatientcare.NurseNavigatorscollaboratewithallmembersofthehealthcareteamtomakesureeachpatientisgettingthebestcareandsupport theyneedthroughouttheircancertreatment.
Centralpointofcontactforallnavigatedpatients;includinginteractionwithmedical,nursing,ancillaryservices.
Provideseducationtopatients,families,andsignificantothers;actsasaninformationresourcetohealthcareprofessionals,patientsandthepublic.
Collectandreportdatafrompatientonbarriers,healthcare,priortreatments.
Trackordercompletionandfollowup.Monitorpatientcompliancewithpatienttreatmentplan.
Assistwithreferralstooutsideresourcesandcarecoordinationasneeded.
Mayattendandreferpatientstotumorconference;followupwithrecommendations.
Collaborateswithmedicalproviders,patientcarestaffandclinicmanagementintheplanningandimplementationofpatienteducation.
Followupandassessallpatientspostcancertreatmentandcontinuetomonitorforany/alllongtermsideeffectsandpsychosocialissues.Referpatientstothepropersupportteamwhenneeded.
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NancyCaserta,RNMariaRapuzzi,RN
BreastHealthNavigatorReport
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TheNurseNavigatorsatStatenIslandUniversityHospitalactaspersonaladvocatesfornewlydiagnosedbreastcancerpatients.Ournursenavigatorsprovidetheirpatientswithcounselingservicessopatientscaneffectivelycopewiththe impactofbreastcancerandsubsequent lifestylechangesthatoccurasaresultoftheirillness.
Nursenavigatorswillassisttheirpatientswiththefollowing:
Organizingappointmentsandnavigatingthroughthehealthcaresystem
Providenecessaryeducationandinformationonavailableoptions,informeddecisionmakingprocess,andrealisticgoalsettinginordertoempowerthepatientandtheirfamilytoactivelyparticipateintheirplanofcare
Providesupportandeducationalmaterials
Answerquestions regardingpatient’supcomingtreatmentplans
Collaboratewithpatientsandtheirfamilies
Providingsupport topreandpostsurgicalpatientsduringhospitalization
Facilitatetheweeklymultidisciplinaryconferences
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ClaudineDemarco,RN
GastrointestinalNurseNavigatorReport
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TheNurseNavigatorpromotestimelyqualitycareviapersonalguidancethroughthehealthcarecontinuum. Theprimarygoalofthenavigatoristodecreasethebarrierstocare.
TheNurseNavigatorwillassistthepatientwiththefollowing:
Orientspatientstothecancercaresystem
Coordinationofappointments, proceduresandtestingwithnecessarysubspecialtiesinatimelymanner
Collaborationwiththemultidisciplinaryteampreandpostoperativesupport
Providespatientandfamilyeducationrelatedtodiagnosis,treatment,chemotherapyprotocols,clinicaltrials,communityresourcesandsurvivorship
Developsandfacilitatessurvivorshipplans
Advocatesonthepatients’behalf
AdditionalActivities:
ParticipatedinthehospitalbasedbiannualOncologyCoreCurriculumbypresentingtheNavigationandGastrointestinalcontent
ActivememberoftheOncologyNursingSocietyandtheAcademyofNurseandpatientnavigators
ObtainedAONNCertification:OncologyNurseNavigatorCertifiedGeneralist
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PatriciaM.Altschuler,BSN,RN
Head&NeckNavigatorReport
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TheroleoftheOncologyNurseNavigatorusesamultidisciplinary approachtoprovidetimelypatientcarefromthebeginningofacancerdiagnosisthroughsurvivorship.TheNurseNavigatorisresponsible foreducating, coordinating,facilitating,andparticipatinginallpatientcare.NurseNavigatorscollaboratewithallmembersofthehealthcareteamtomakesureeachpatientisgettingthebestcareandsupporttheyneedthroughouttheircancer treatment.Uponcompletionofcancer treatment,NurseNavigatorscreatesurvivorshipcareplansforeachpatient,whichincludesabriefsummaryofthecaretheyreceived,aswellaslongtermsideeffects,followupappointmentsandcontactinformation.Acopyofthistreatmentplanisthensenttotheirprimarymedicalphysiciantofurtherfacilitatecollaboration inmedical care.
Collaborateandcoordinatepatientcare inatimelymannerfromdiagnosisthroughcompletionofcancer treatment
Educatepatientsandtheirfamiliesonallcancer treatments,sideeffectsandconcernsbefore,duringandaftertreatment
ParticipateinmonthlyCMEapprovedHeadandNeckconference tofacilitateamultidisciplinary planofcareforeachpatient
Followupandassessallpatientspostcancer treatmentandcontinuetomonitorforanylongtermsideeffects,aswellasanypsychosocialissues.Referpatientstothepropersupportteamwhenneeded(nutrition,socialworkers,financial,etc.)
Providesurvivorshiptreatmentplanstoallpatientsandtheirprimarycarephysicianstofacilitatecollaborationthroughoutthehealthcare team
TakepartinyearlyHeadandNeckcancer screeningsandcontinuetoencourageandsupportallnewlydiagnosedpatientsingettingthetreatmenttheyneed
Encourageallpatientsandtheir familymembers toparticipate inongoingsupportgroups,whichhelpstoovercomefearsandconcernsbefore,duringandaftertreatment
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JudyValitutto,RN
LungNavigatorReport
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TheLungCancerNavigatorguidesthepatienttothemostimportantinformationandresourcesforwheretheyareintheirlungcancerjourney.Thisincludesthenewlydiagnosedpatient,patientswhohavecompletedtreatment,lungcancercaregivers,andforpeoplewhoarecurrentlyintreatment.
Coordinationofcareforappointmentssuchasmedical,cardiology,interventionalradiology,radiationandpulmonaryappointments.
Provideeducationtopatientswhowillbereceivingchemotherapyand/orimmunotherapy.
Assistthepatient,familyandcaregiverswhohavequestionsregardingfinancialassistance,socialworkintervention,supportgroupsandsmokingcessations.
CoordinatesThoracicConferencewiththemultipledisciplinaryteam.(Pulmonary,Surgery,Oncology,InterventionalRadiology,andRadiation)
CoordinationwiththeCaseManagementteamforpatientswhoarehospitalizedincludingdiscussionofthedischargeplan.
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NoraGoldbergDepartmentofRehabilitationMedicineCancerReport
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SpeechTherapy
Approximately20patientsamonthfordysphagiaconsultation.
CollaboratesconsistentlywithENTformoreadvancedsurgicalandreconstructiveproceduresonindividualswithheadandneckcancer.
Ongoingeducationwithnursingstaffinmanagingpost-surgicalheadandneckcancerpatients.
Ongoingassessment/treatment fordietmodificationandsafefeedingstrategieson3Binpatientoncologyunit.
Improvedawarenessthroughoutthehospitalforpatientswithheadandneckrelatedcancersandtheirneedfordysphagiaand/orvoiceservices.
Collaboratedwithadministration,patientsafety,qualityriskmanagement,and ENTindevelopingaplantobetteridentifyandadequatelycarefortotallaryngectomies.
AssistingENTindevelopingeducational toolsfornursing/medicalstaffand todevelopasimulationlabinCenterforAmbulatorySurgery.
InstrumentalassessmentstoincludeModifiedBariumSwallowStudies(MBS)andFiberopticEndoscopicEvaluationofSwallowing(FEES)forawidervarietyofoncologicalpatients.
WorkingalongsidePalliativeCareteamforadvancedillnesspatients.
Ongoingcollaborationamongspeechdepartment,respiratorytherapy,pulmonaryandstaffdevelopmentregardingeducationofstaffforvoiceprosthesisandtracheostomycare.
Participated incontinuingeducationcoursesfortechniquesusedwithpatientsdiagnosedwithheadandneckcancer.
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SpeechTherapy
Utilizingemailingamongteammembersaboutpre-treatmentpatientstoshareSpeechLanguagePathologyrecommendations.
Optimizingtheuseofthenursingnavigatorforearlyidentification forpatients’pre-treatmentinterventions(i.e.education,exerciseprogram,dietmodification).SpeechLanguagePathologyfollowupaspatientmovesthroughindividual careplan.
Oralcancer screeningsforthecommunity.
Participation inmonthlytumorboardforheadandneckcancer.
Oral,Head&NeckCancer supportgroupheldmonthly.
Additional Outpatientservices
Createdsocialmediaforumsforcommunicationwithinthecommunityregardingsurvivorship.
Participated incontinuingeducationcoursefortechniquesusedwithpatientswithheadandneckcancer.
ReferralfromcommunitySpeechLanguagePathologyforModifiedBariumSwallowStudies(MBS).
Useofasharedtrackingsystemforpatientswithheadandneckcancer.
Increasedpatientsatisfaction,reducedweightloss,reducedtreatmentinterruptions,andpostchemotherapyradiationtherapyoutcomeswithmorestandardizedprophylacticPEG placement.
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OccupationalTherapy
OTtreated66patientsintheUpperExtremityLymphedemaProgram.Weprovided336visits.Thissignificantlyexceeds171visitsfor38patientsprovidedin2016.
WearereceivingmorereferralsfromspecialistswithinSIUH(ComprehensiveBreastCenter,OutpatientOncologyServicesandRadiationOncology)aswellasoutsideoftheNorthwellHealthSystem.
EstablishedaprofessionalrelationshipwithNursePractitionersatNYU.
PediatricRehabilitation
Twopatientswerereferred toOutpatientservice.
Oneofthesepatientswasnotrecommendedforongoingservices. Thesecondchildevaluatedduringthe2nd quarterwasreferredforOTandPTservices,butwasre-hospitalizedandservices couldnotbeprovided.
PhysicalTherapy
Provided200visitstopatientswithLowerExtremityLymphedema.
293visitswereprovidedtopatientsonHospiceService.
Neuropsychology
OnepatientwasreferredandseenforNeuropsychologyevaluationin2017.
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DeirdreQuirk,CTRCancerRegistryCoordinator
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CancerRegistryReportTheCancerRegistryisadatabaseestablished toimprovecancercare throughthecollection,maintenance,analysisandproductionofreportsfromoncologydata.TheentiredatabaseincludesallcancercasesdiagnosedandtreatedatStatenIslandUniversityNorthwellHealthsince theregistry’sreferencedateof2002.Securitymeasuresforinsuringconfidentialityofdataarestrictlyfollowed.
TheCancerRegistryfrequentlyprovidesoncologydataforclinical studies,nursenavigatorsandthegeneticcounseloraswellasforthepurposeofbothshorttermandlongtermplanningfortheinstitution.Italsoservesasareviewofhospitalutilizationandqualityofcancercare.Toinsurecompleteandaccuratedataabstractingandreporting,theregistrystaffandtheCancerCommitteechairmanperformanongoingqualitycontrolandreviewofcompletedcancercases.
TheCancerRegistryisalsoresponsible formaintaininga90%fiveyearfollowuprateonalleligible cancerpatients,arequirementoftheAmericanCollegeofSurgeons,CommissiononCancer. An80%followuprateforalleligible patientsisalsorequired.Completeandaccurateinformationisessential forcompliancewiththestandardsoftheCommissiononCancerandtoprovidehighqualitysurvivaldata.
In2017,thefivemajorcancer sites(analyticcases)treatedherewere:
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Primary Site Total Percentage
Breast 275 19.43%
BronchusandLung 188 13.29%
HematopoieticReticuloendothelial System
101 7.14%
Bladder 96 6.78%
Colon 90 6.36%
AllOther Sites 665 47%
Total 1,415 100%
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In2017,1,746newcancercaseswereaddedtoourcurrentCancerRegistrydatabase.Ofthenew,1,746casesaccessioned,1,415wereanalytic(newlydiagnosedand/ortreatedatStatenIslandUniversityHospitalNorthwellHealth)and331werenonanalyticcases(previouslydiagnosedandtreatedelsewherebuttreatedatSIUHforrecurrentorpersistentdisease).DistributionofcasesbyAJCCStageincludesunknownstagepatientsinitially diagnosedatSIUHbutthereisnotenoughinformationforaccuratestagingandnotapplicable (NA)cancersthatdonothaveAJCCstagingsuchasbonemarrowandbrain.
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Stage TotalCases %ofTotalCasesStage0 133 9%Stage1 328 23%Stage2 174 12%Stage3 105 8%Stage4 256 18%NA 242 17%Unknown 177 13%TotalCases 1,415 100%
Stage09%
Stage123%
Stage212%
Stage38%
Stage418%
NA17%
Unknown13%
2017AnalyticCaseStageDistribution
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MelissaPanzo,RNOncologyResearchReport
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TheDepartmentofResearchwithinMedicalOncologycontinuestocollaboratewiththepatientcareteamtoenrollpatientsintooncologyrelatedtrials.Wecontinuetoofferourpatientpopulationaccesstoclinicaltrialsthroughcooperativegroupaffiliations,industrysponsored studiesandinternalinvestigatorinitiatedresearch.
OurOncologistsmaintainactiveNationalCancerInstituteInvestigatoridentificationnumbersandparticipateasmembersofourOncologyClinicalInvestigationsCommittee(OCIC)whichservesasaforumfordiscussingnewstudies,enrollment/screeningstatisticsandotherimportantresearchdevelopments.WeareproudtoreportthatourResearchCoordinator,ResearchNurseandManagerofClinicalResearchmaintaincertificationwiththeAssociationofClinicalResearchProfessionals(ACRP).
In2018theOCICmeetingwillberenamedtheResearchTransitionMeeting,thismeetingwillhavethesamegoalsastheOCIC.
Atotalof1,415analyticalcaseswerereportedtotheDepartmentofResearchfor2017.Enrolling6%ofouranalyticcasesforaccreditationequatesto85enrollments.Enrolling8%ofouranalyticalcasesforcommendationequatesto113enrollments.
Ourtotalenrollmentfor2017is196,meetingcommendationstatusfortheyear.
TheDepartmentofResearchwithinMedicalOncologycontinuestocollaboratewiththepatientcareteam,toenrollpatientsintooncologyrelatedclinicaltrials.
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PaulaMcAvoy,RNPalliativeCare
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MissionStatementThemissionofUniversityHospiceistomeettheneedsofterminallyillpatients,theirfamiliesandlovedones,byprovidingcomprehensivepalliativecarefocusingonphysical,social,emotionalandspiritualsupport.
ScopeofServiceUniversityHospiceislicensedtoprovidepalliativecareforterminallyillpatientsandtheirfamiliesinStatenIsland,Brooklyn&Queens.An8bedhospiceresidentialfacilityisavailableonthecampusofEgerRehabilitationCenter.
PatientCareStatisticsTotalReferrals 1,235TotalAdmission 556AverageLengthofStay 59MedianLengthofStay 18
*QualityImprovementactivitiesutilizeHCAHPSfamilysurveydata.
*Collectionof7NationalQualityForummeasuresrequiredbyCMScontinues. In2017CMSaddedanalysisofvisitsinthe last3and6daysoflife.FirstpublicreportingofNationalQualityForumscoresbeganinthesummerof2017.
*Effortstoimproveaccesstovolunteerservicescontinuedwithsmallincrementalincreasesover2016.
*EmergencyPreparedness- ParticipationinlargescaleDOHdrillandanalysisofall2017actualevents.PolicyandpracticeupdatedtoincludenewCMSregulation.ActiveshooterdrillcompletedfortheAddeoResidence.
*InfectionControl- Focusin2017onincreasingratesofinfluenzavaccinesamongHHA.“Secretshopper”handhygieneobservationsbeganin2017inadditiontoannualstaffvisitswithexcellentcompliance.
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MissionStatementThemissionofthein/patientpalliativecareserviceistomeetthephysical,social,emotionalandspiritualneedsofpatientswithanadvancedillness.Theseneedsareassessedandaddressedthroughaconsultingserviceconsistingofphysicians,nursepractitioners,nursessocialworkersandpastoralcarestaff.
Totalnewin/PtConsults-1222TotalVisits—3736
*ContinuationofAdvancedIllnessinitiativeswithPalliativeCarecurrentlyinICUrolledout in2016toCCUandEmergencyRoomin2017.AllpatientsassessedbyPalliativeCareteamforpotentialHospiceservices.
Plan2018
*ObtainHospiceEMR
*IncreaseHospiceserviceavailabilityinBrooklyn
*IncreasePalliativeCareservicepenetrationincludingsubmissionofaproposaltobringpalliativecareservicestotheSouthCampus
*Continueinitiativesinemergencypreparedness,fallprevention,infectioncontrolsurveillanceand“endoflife”education
*DSRIPinitiativescontinuetofocusonintegratingpalliativecareintoStatenIslandLongTermCareFacilities
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CarolynSimone,LCSWPracticeManagerCommunityOutreachCoordinator
CancerEducationandPreventionReportCommunityOutreachYearEndSummary
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CANCEREDUCATIONANDPREVENTIONREPORT2017
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TheCancerEducationdepartment iscommittedtoearlycancerdetectionbyprovidingfreescreeningsandeducationalseminars tothecommunity.Screeningsarescheduledforbreast,skin,headandneck,andcolorectalcancer. Educational seminarsandhealthfairsarescheduledtoprovideeducationandawarenesstothecommunity.
TheCancerEducationdepartmentworkswiththeAmericanCancerSocietytoprovidecommunityawarenessandcancerpreventionwitheducationallecturesandactivities suchas:MakingStridesAgainstBreastCancer,StatenIslandQuits,andLookGood…FeelBetter. Inaddition,theCancerEducationdepartmentworkswithTheLeukemia&LymphomaSocietyandparticipatesintheirannualLighttheNightWalk.
Tohelpwiththeemotionalneedsofourpatients,CancerServicesprovidesmonthlysupportgroupsforbreastcancer,ayoungadultbreastcancersupportgroup,oral,headandneck,ageneralcancer supportgroupandacaregiver supportgroup.
TheCancerEducationdepartmenthasa“Cancer InformationLine”availabletothepublictocallandobtaininformationonourservices,brochures,andaboutupcomingevents.Thetelephonenumberis718-226-8888.Inaddition,wepostacalendarofupcomingeventsontheSIUHwebsite.
Throughouttheyear,weparticipated inlocalandnationaleventstorecognizesurvivorsofcancer. ThemaineventheldyearlyistheNationalCancerSurvivorsDay,adayofrecognition forallsurvivorsofcancerandtheirfamilies.
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2017SIUHScreeningsandPreventionPrograms
CANCERSERVICESPROGRAM
TheCancerServicesProgramofStatenIsland,whichisacooperativeendeavorwithNYSDOHtoprovidefreebreast,cervical andcolorectal cancer screening totheunder-insuredanduninsuredpopulationonStatenIsland.Additionallythisprogramprovidesallthediagnosticworkuprelated toanabnormalfindingandnavigationintotheMedicaidCancerTreatmentProgramforeligible individualsdiagnosedwithbreast,cervical, colonorprostatecancer.Weprovidecommunityeducationonthesecancersandalsopartakeinactivities specific tocervical, colonandbreastcancerawarenessmonths.WeworkwiththeDOHonMainStreetsGoBlueinMarchtoincreasecoloncancer screeningsandawareness.IncooperationwithSIUHwedistributeFITkitsduringMarchtoanyoneapplicable (averageriskclients).Wealsohaveaspecial freecolonoscopyprogramthatwerunincooperationwiththeNYCDOH.Wehavebeenfundedannuallytoprovide80freecolonoscopies.
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BreastCancerScreenings
CommunityNeed - Breastcancer isoneofthehighestcancersinthecommunity.Evidence isfoundintheNewYorkStateDOHCancerRegistryandSIUHtumorregistryfrequencyreport.ThisscreeningiseffectivebecausewehaveahighnumberofbreastcancerdiagnosesinRichmondCounty.Nationalguidelines andEvidencebasedinterventions followedareAmericanCancerSociety,NCCNandNCI.Inaddition,thesescreeningsareeffectivebecausetheyaredetectingbreastcanceratanearlier stage,thus,decreasing thenumberofpatientswithlate-stagedisease.679womenhadbreastcancer screenings.Clinicalbreastexams,screeningmammograms,bilateralandunilateraldiagnosticmammograms,breastultrasoundsandbiopsieswereperformedtotaling1,221and6breastcancerdiagnosesweremade.
Followupprocess
Clients foundtohaveanabnormalfinding(breast,cervical orcolorectal)arecontactedwithin72businesshourstoprovidecasemanagementservices toaddressanybarriers thatcouldpreventordelaytheir (patients)seekingcare.ThekeycomponentstoourCaseManagementisassessment,planning,coordinationandresourcedevelopment.ClientsarecalledbyCMwithin72hours(preferablyaftertheMDhasspokenwiththeclient)andtheroleoftheCMisexplained totheclient. Abarrierassessmentisperformedandaclientcareplanformulated.Barriers identifiedaredocumentedaswellasthestepsperformedtoresolve.Clientsareassistedwithappointmentremindercallswhichareplacedtoclients1-2dayspriortoappointment.Abarrierassessmentisagainprovidedatthattime.Ifaclient isfoundtohaveapre-cancerousorcancerdiagnosistheyarereferredimmediately totheDQE(designatedqualifiedentry)toevaluateandstartapplication fortheNYSMedicaidCancerTreatmentProgram(MCTP).Clientsnoteligible arereferred totheslidingscale (clientswhoarenotdocumentedarenoteligible forMCTPbutareeligible forslidingscale).
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MCTPisaMedicaidprogramforeligible personswhoarefoundtobeinneedoftreatmentforbreast,cervical, colonorprostatecancer (andsomepre-cancerousconditionsneedingtreatment)Onceaclient isenrolled theyreceive fullMedicaidcoverageforaninitial enrollmentperiodasdeterminedbythetypeofcancerbeingtreated.Recertification isyearly,iftheclient isstillinneedoftreatment.
ColonScreenings
CommunityNeed - Colorectalcancer isoneofthehighestcancersinthecommunity.Evidence isfoundintheNewYorkStateDepartmentofHealthCancerRegistryandSIUHtumorboardfrequencyreport.Thisscreeningiseffectivebecausewehaveahighincidence inRichmondCountyanditcandecrease latestagedisease. NationalguidelinesandEvidencebasedinterventionsfollowedareAmericanCancerSociety,NationalComprehensiveCancerNetwork,andNationalCancerInstitute.42fitkitsweredistributedwithinstructionforaverageriskclients.Outof42kits,39werenegativeand3werepositive.Colonoscopieswereperformedonthe3positivefitkits,2colonoscopieswerenegativeand1hadahyperplasticpolyp.TheCancerServicesProgramDirectornotifieseachclientoftheirresults.Ifthereisanegativefinding,eachclient isnotifiedoftheirresultsviamail.Ifthere isapositivefinding,eachclient isnotifiedoftheirresultsviaphone,referral isgivenandpatientisfollowedthroughtodiagnosis.
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1/1/17-12/31/17ProcedureCountandResultsBreast Cervical ColorectalTOTALBREASTSCREENED TOTALCERVICALSCREENED TOTALCOLORECTALSCREENED TOTALSCREENED
679 124 42 701CLIENTS198ClinicalBreastExams 123Pevlic/PapExams 42FITKitsDevolped593ScreeningMammograms 114HRHPVtests 39Negative65BilateralDiagnosticMammograms 8GYNConsults 3Positive151UnilateralDiagnosticMammograms5ColposcopywithBiopsyandEcc 3GIConsults179BreastUltrasound 1Colonoscopy12StereotacticBiopsy 2Colonoscopywithbiopsy18CoreBiopsy1FNA4ExcisionalBiopsy27SurgicalBreastConsultsResults Results Results3InvasiveBreastCancer 3CIN1 2Negative1LobularCarcinomainsitu 1CIN11 1HyperplasticPolyp2DuctalCarcinoma
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SKINCANCERSCREENING
NameofActivity:FREESKINCANCERSCREENINGTypeofcancer
Meetingdateneedwasdiscussed(MM/DD/YYYY)
TypeofActivity (PreorScr)
Guidelinesusedtodesignactivity)
DateofActivity(MM/DD/YYYY)
Participants(targetaudience, #inattendance)
Outcomes/Follow-upprocessforparticipantsw/positive findings(Screeningonly)
Effectiveness ofActivity(value,lessonslearned,recommendations forimprovements)
Skin Feb,7th,2017
FREESKINCANCERSCREEN
AmericanAcademyofDermatology
TUESJUNE27TH,2017
27
NORMALFINDINGS•24ABNOMALFINDINGS•3
Thedermatologistinformed thepatientsoftheresultsimmediatelyfollowing theexamination.Ifthereisanabnormal finding,thedermatologist maderecommendations forfollowupandareferralwasmade.Theserecommendationsinclude, butarenotlimited to,areferral toadermatologist withorwithout biopsy.Patientsweregivenalistofdermatologists andinstructed toscheduleanappointment with thedermatologist oftheirchoice forfollow-up.
Participants areabletoaccessthesefreeservicesbecauseitisadvertisedinthecommunity.Thescreening wasusefultothecommunitybasedonthepositivefeedbackfromtheparticipants. Itisaneffectivescreeningbecausethereisaneedforthisscreeninginthecommunity.According todatefromtheNYStateCancerregistryandSIUHcancerregistryreport, thereisanincreaseinthediagnosisforskincancer, aswellasanincreaseinlatestagedisease.
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HEADANDNECKSCREENING
NameofActivity:FREEHEADANDNECKSCREENINGTypeofcancer
Meetingdateneedwasdiscussed(MM/DD/YYYY)
TypeofActivity (PreorScr)
DateofActivity(MM/DD/YYY
Participants(targetaudience,#inattendance)
Outcomes/Follow-upprocessforparticipantsw/positive findings(Screeningonly)
Effectiveness ofActivity (value,lessonslearned, recommendations forimprovements)
HeadandNeck
Feb,7th,2017
FREEHEADANDNECKSCREEN
TUESNOV14TH,2017
12
NORMALFINDINGS•8ABNORMALINDINGS•4
TheENTphysicianinformedthepatientsoftheresultsimmediatelyfollowing theexamination.Iffurtherevaluationwasneeded,thephysicianmaderecommendations forfollowup.Therecommendation include,butarenotlimitedto, areferral toanENTphysicianwithorwithout biopsy.Iffurther evaluationwasneeded, anappointmentwasmadeimmediatelyatthescreening.
Headandneckscreeningsareeffectivebecauseitprovidesearlydetection ofheadandneckcancer.Participants areabletoaccessthesefreeservicesbecauseitisadvertisedinthecommunity.Thescreeningwasusefultothecommunitybasedonthepositivefeedbackfromtheparticipants. Nexttime,wewill include asurveyforourscreening.
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COLORECTALSEMINARNameofActivity:ColorectalSeminar
Typeofcancer
Meetingdateneed
wasdiscussed
(MM/DD/YYYY)
TypeofActivity (PreorScr)
Guidelinesusedtodesignactivity
DateofActivity(MM/DD/YYYY)
Participants(target
audience, #inattendance)
Effectiveness ofActivity (value,lessonslearned,recommendations
forimprovements)
Colon 2/7/2017
Content includedfactsaboutColonCancerScreening forprevention andearlydetection andpreventivenutrition.
NCCN 3/29/17 25
Anevaluationtool wasgiventoeachattendeeaftertheseminar.Theevaluationindicated thattheylearnedabouttheimportance ofscreeningforColon Cancer, andthatthepresentation gavethemtheknowledgeandsupport tomakehealthydecisionsabouttheirlifestyle.Inaddition, attendeeslearnedhowtoaccessandobtainareferral forafreecolonoscopy.Fitkitswerealsoavailable.
ALBANIANCOMMUNITY HEALTHFAIR/COLONCANCERPREVENTION
NameofActivity:AlbanianCommunityHealthFair/Colon CancerPrevention
Typeofcancer
Meetingdateneedwasdiscussed(MM/DD/YYYY)
TypeofActivity (PreorScr)
Guidelinesusedtodesignactivity
DateofActivity(MM/DD/YYYY)
Participants(targetaudience, #inattendance)
Effectiveness ofActivity (value,lessonslearned,recommendationsforimprovements)
Colon 2/7/2017 AlbanianCommunityHealthFair/Colon CancerPrevention
NCCN 3/25/17 75TherewasacommunityneedtoreachouttotheAlbanianCommunity.Positivefeedbackwasreported fromtheattendees.