Grand River Regional Cancer Center (GRRCC)

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Organized Diagnostic Assessment
Demonstration Projects
Grand River Regional Diagnostic Assessment Unit
Robinne Hauck, Jennifer Parkins, Mark Berry, Colleen Graham
Grand River Regional Cancer Center (GRRCC)
Project Summary
Program Goals:
1. Timely access for diagnosis and
The Thoracic Diagnostic Assessment Unit
assessment of patients with suspected
at Grand River Regional Cancer Centre
lung cancer
provides timely access, assessment,
2. Multidisciplinary care by thoracic team
diagnosis and follow-up for patients
3. Comprehensive coordinated care by
suspected of having lung cancer.
nurse navigator to avoid gaps in patient
4. Implementation of evidence-based care
• Long wait times for CT Scan
guidelines for thoracic surgery
• Long wait times for referral to
respirologist or thoracic surgeon
Critical Interventions:
• Non-standardized treatment plans
• Development of a thoracic disease site
• Multiple unmet needs of complex
team, led by a Respirologist and Clinical
Nurse Specialist to review clinical
• Uncoordinated care pathway for patients
pathways and develop standardized
• High morbidity and mortality in Thoracic
approach to care
surgery patients
• Implementation of diagnostic guideline
of 2 weeks
• Wait time tracking and follow-up
• Partnerships with primary care
We implemented a thoracic diagnostic
physicians to order chest CT at the time
assessment unit in a Integrated Cancer
of referral and review medical history
Program. We secured clinic space within • Bringing thoracic surgeons and
the cancer centre and provided the
respirologists into joint weekly clinics to
necessary supports, including office
reduce the time between appointments.
supplies and tools needed to provide
thoracentesis. We worked collaboratively
• 157 cases seen by DAU
with two of the nine respirologists and one
• Time from referral to diagnosis reduced
of the thoracic surgeons who acted as
from 113 days (June 2007) to 69 days
champions for this unit.
(Sept 2008)
A Nurse Navigator (0.6 FTE) was
• 57% of cases referred to Thoracic
introduced to screen patients; assess
family needs; link patients in to the team;
Benefits reported by patients:
discuss care plans; and provide
Peace of mind, support, compassion and
supportive care.
Relationship built with primary care
Improvement in pain
through open referral basis to family
Nurse and Surgeon’s attention to
physicians to improve accessibility and to
questions and easily understood
build capacity.
Top 3 achievements
1. Team commitment and collaboration to
ensure patient journey was without
2. Timely access to diagnosis for
3. Role of nurse navigator in the care of
treatment and follow-up phases
Top 3 challenges
1. Recognition of a new clinic in an ICP
for patients who did not have an actual
diagnosis of cancer.
2. Difficulty gaining commitment for
allocated times for diagnostics
3. Surgeon coverage for DAU
Next Steps:
Overall, the patient experience has
been well supported by the introduction
of the DAU. The nurse navigator is able
to follow the patient through all phases
of care including diagnosis, treatment,
palliation and follow-up. The DAU has
provided more timely access to
diagnostic procedures. Gaps are
avoided by following the processes of
care for the patient and their family.
• In November 2008 the program
secured booked CT guided biopsy
slots at two centres in the LHIN
• Thoracic DAU to be integrated into
Surgical Oncology Program;
continuation of weekly clinics
• Clinic Nurse role to change to a CNS
role, with a focus on individuals with
lung cancer and their family within the
• Engagement of regional physicians
• Thoracic Disease Site Team, with a
focus on wait time from CT to
diagnosis and Multidisciplinary Cancer
• Open to opportunities for knowledge
transfer to other disease site teams in
the development of other Diagnostic
Assessment Units

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