New Synoptic Operative Standards Paving the way for Updated Best Practices of Cancer Care.
Medical record documentation is an essential component to ensuring patient safety and quality of care in oncologic surgery. Surgical procedures are usually documented in narrative operative reports which are subjective and may lack important information. There is a growing number of evidence-based studies on the use of synoptic operative standards that are associated with improved patient outcomes, including survival and quality of life.
On January 1, 2020, the Commission on Cancer (CoC) launched new cancer program accreditation standards which included six synoptic operative standards, 5.3 through 5.8. The intent of these standards is to establish evidence-based best practices for cancer-directed surgeries performed for breast, colon, lung, melanoma, and rectal cancers.
Two of the new standards, 5.7 (rectum) and 5.8 (lung) were phased-in and effective January 1, 2021. Both standards require specific data elements to be added to pathology reports in addition to the synoptic data elements already required by the College of American Pathologists (CAP).
The remaining synoptic Standards, 5.3-5.6, will be phased in beginning 2022 and will require operative narrative reports to include a synoptic format and data elements similar to CAP protocols. The CoC anticipates full implementation of all six standards to be completed by January 1, 2022.
For compliance, accredited facilities must achieve a 70% compliance on pathology reports for all eligible rectal and lung cancer patients in 2021 and 80% by the year 2022. For Standards 5.3 – 5.6 a 70% compliance rate will be required in the operative reports in 2023 and 80% in 2024 and beyond.
Facilities are encouraged to be proactive about working with EMR vendors and clinical informatics staff to implement the synoptic formats as soon as possible. Some facilities have reported taking 3-15 months to implement and test prior to go live to ensure they are working correctly. The CoC plans to release templates for this purpose, however a facility may elect to develop their own format to meet the requirements.
The Cancer Committee is charged with monitoring compliance. Cancer program coordinators, registrars, surgeons, and pathologists are encouraged to work with their departments and staff to determine the best process for reporting results and frequency of Cancer Committee review.
Cancer Surgery Standards Program
To support the cancer surgery standards, the ACoS launched the Cancer Surgery Standards Program (CSSP). The CSSP is dedicated to improving the surgical quality of care given to cancer patients and educating surgeons and staff on the value and benefit of synoptic reporting. In 2019 the CoC met with content experts to create comprehensive synoptic operative formats to serve as the operative report of record. These elements, required for CoC accreditation, provide a crosswalk to the American Joint Committee on Cancer (AJCC) staging and National Cancer Database (NCDB) coding schemes used by surgeons, pathologists and cancer registrars.
Education and Resources
The CSSP is actively collaborating with physicians and registrars to develop resources for each standard, including short videos, FAQs, checklists, and toolkits. Facilities may share these resources with their Cancer Committee or in other appropriate meetings, such as cancer case conferences. Resources will be posted on the CSSP webpage as they become available.
Integration of the synoptic operative report recommendations as CoC cancer program accreditation standards is one step facilities can take to improving cancer-directed outcomes. When implemented as designed, synoptic operative reports will reduce the variation in the way cancer-directed surgeries are performed and documented. Information gathered from the implementation process and elements documented in the medical record will be used to further the study and research of patient outcomes and contribute to evidence-based medicine across the country. The CSSP is dedicated to educating surgeons, pathologists and cancer registrars on the standards and providing resources in the coming years to support and maintain the highest levels of quality care.
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