Abstract
Background
Prognosis of cutaneous head and neck malignant neoplasms is related to type, site, and histologic feature but may also be influenced by delays in the referral process. Treatment aims to address the primary lesion and when necessary the secondary disease but at the same time maintaining quality of life and minimizing cosmetic deformity. The management plan should ideally be the “product” of a multidisciplinary team (MDT) approach of dermatologists, surgeons, oncologists, pathologists, and radiologists.
Aims
The purposes of the study were as follows: (i) to review current documentation practice of cutaneous head and neck malignancies in a district hospital, (ii) to generate an MDT-approved data collection proforma, and finally (iii) to reaudit documentation of head and neck skin lesions based on the “new” standardized proforma. The MDT-approved proforma was instituted in an effort not only to collect data in a coherent and structured way but also to achieve early diagnosis and avoid delays from urgent referral to treatment with the aim of curing disease and restoring patients to as near-normal appearance and quality of life as possible.
Methods
The notes of patients with head and neck cutaneous lesions were prospectively audited for a 6-month period (August 2006–January 2007). The presence and absence of a minimal standardized data set required for MDT discussion and review were recorded.
Results
Documentation was deficient and a need for change in practice emerged. An MDT-approved data collection standardized proforma was designed and distributed throughout the hospital departments involved in management of patients with head and neck cutaneous lesions. The notes of these patients were prospectively reaudited through a second cycle for a 6-month period (February 2007–August 2007). The completion and deficiency of sections of the MDT-approved data collection standardized proforma were recorded, resulting in closure of the audit loop.
Conclusions
The data documentation for head and neck cutaneous lesions has significantly improved after the implementation of an MDT-approved data collection standardized proforma. This has resulted in improved patient quality of care and progression on appropriate management plans.
1
Introduction
Head and neck oncology multidisciplinary team (MDT) meetings are held to establish a correct diagnosis and an appropriate treatment plan for each individual patient. The aims of an MDT approach are to maximize the duration of disease-free period and overall survival while minimizing morbidity. Although head-neck cancer has increasingly being addressed via an MDT decision plan, cutaneous head-neck malignancies are often overlooked or not routinely discussed in these meetings. That is perhaps because the otolaryngologists were not traditionally involved in the surgical management of these lesions. With the introduction of facial plastics in the otolaryngology curriculum, increasingly more and more otolaryngologists have to deal with skin cancer .
The aims of this article are (i) to review current documentation practice of cutaneous head and neck malignancies in a district hospital, (ii) to generate an MDT-approved data collection standardized proforma, and finally to (iii) reaudit documentation of head and neck skin lesions based on the “new” standardized proforma.
2
Materials and methods
Best practice and standard was established as being a minimal standardized data set required for MDT discussion and review, and the standard was set at 100% ( Table 1 ).
| Standard |
|---|
| Patient identification |
| Name |
| Date of birth |
| Hospital number |
| Referral |
| Source |
| Date |
| First consultation |
| Lesion |
| New/recurrence + details |
| Site |
| Size |
| Surface |
| Shape |
| Color |
| Surroundings + lymphadenopathy |
| Photograph(s) |
| Differential diagnosis |
| Management plan |
| Associated comorbidities |
| Operation |
| Date |
| Description |
| Type of closure |
| Histologic examination |
| Date |
| Type |
| Margins |
| Clearance |
| Follow-up |
| Dates |
| Complications |
| Recurrences |
| Further operations + dates |
One hundred sets of medical notes were randomly selected from a computerized list of head and neck cutaneous lesion patients who had undergone surgery within the Ear, Nose, and Throat Department at Leighton Hospital, Crewe, United Kingdom, during a 6-month period between August 2006 and January 2007. The notes were reviewed by a single observer with regard to presence and absence of the minimal standardized data set. The results were presented to the Departmental Audit Meeting. After the deficiency in data documentation, a decision was made to establish a change in practice by designing an MDT-approved data collection standardized proforma that would incorporate the minimum data set ( Appendix A ). The standardized proforma was distributed throughout the hospital departments involved in management of patients with head and neck cutaneous lesions. A second audit cycle was commenced a month later with the addition of the standardized proforma that was inserted securely into the medical notes of these patients. One hundred sets of medical notes were randomly selected using the identical criteria in the first audit loop during a 6-month period between February 2007 and August 2007. As previously, the notes reviewed by a single observer with regard to the completion and deficiency of sections of MDT-approved data collection standardized proforma were recorded. The completion of this second cycle resulted in the closure of the audit loop.
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