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Establishing a Head and Neck Cancer Reconstruction Pathway
Marco Maricevich, Oguz Acarturk, Mario Solari
2014-03-03
Presenter: Marco Maricevich
Affidavit:
Resident has been involved in all steps of this project.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
Oncological defects of the head and neck represent one of the most challenging and complex procedures of the reconstructive surgeon. In the current literature, there is lack of standardization on the care of these patients. Clinical pathways promote organized and efficient patient care based on evidence-based practice.
Objective
To analyze the implementation of a clinical pathway for head and neck oncological reconstruction at our institution. We expect improvement in safety, efficiency, and patient outcomes along with invaluable opportunity for data collection and analysis.
Methods
The development of this clinical pathway resulted from multiple monthly meetings with hospital administration representatives and all teams involved in the care of the head and neck cancer patients; such as ENT, plastic surgery, anesthesiology, critical care, speech pathology, nutrition, general surgery, operating room staff, and floor and ICU nurses.
Results
Our clinical pathway for head and neck oncological reconstruction consisted of multiple standardized protocols stratified in preoperative care (screening, work up, imaging, biopsy, coordinated multidisciplinary same day consultations, and medical clearance), operative care (OR setup, feeding tube placement), and postoperative care (standard order set, planned imaging/procedures to rule out surgical leak, and further outpatient follow up).
Conclusion
A clinical pathway is a management tool for improving coordination of care across specialties, standardizing care, and expediting diagnosis and treatment. We believe its implementation at our institution will reduce the variability in clinical practice, and improve clinical outcomes. Data collection and analysis from the clinical pathway will help us better understand and address the needs of this complex patient population.
