Developing Organizational Requirements to Standardize Delivery and Improve Quality of Acute Leukemia Care in Ontario
Abstract
:1. Introduction
2. Setting
3. Methods
3.1. Defining Criteria
3.2. Literature Selection
3.3. Extraction of Standards and Requirements
3.4. Synthesis and Analysis
4. Results
GENERAL | |
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1.1 | The Centre shall have a clearly defined organizational structure [11]. |
1.2 | The Clinical Program shall consist of an integrated medical team housed in a defined location(s), including a Clinical Program Medical Director(s), who is responsible for the medical aspects of the operation of the service, in collaboration with appropriate facility administrators. This includes the design of the diagnostic pathway, resource use, and reporting standards [11]. |
1.2.1 | The Centre should consider the organization of current services to allow the development of disease-specific clinics where patient numbers are sufficient [12]. |
1.3 | The Centre shall work to implement the current version of Complex Malignant Hematology Models of Care Recommendations [13]. |
1.4 | The Clinical Program shall be located in a facility that is licensed, registered, or accredited by Accreditation Canada [14]. |
1.5 | The Centre shall comply with the current versions of the Ontario Health (Cancer Care Ontario) standards for the delivery of systemic treatment including, but not limited to, the Regional Models of Care for Systemic Treatment: Standards for the Organization and Delivery of Systemic Treatment, as appropriate to their designated level of service [7]. |
1.6 | The Centre shall comply with the current version of the Ontario Health (Cancer Care Ontario) guidelines for the safe administration of systemic therapy including, but not limited to, the following reports: |
1.7 | The Centre shall participate as part of a Provincial Acute Leukemia Network developed by the Regional Cancer Programs in partnership with Ontario Health (Cancer Care Ontario) [2,14]. |
1.7.1 | The Centres shall have clear and reliable systems (e.g., processes, tools) for communicating with relevant health care professionals at other service sites [11]. |
1.7.2 | The Transplant and Acute Leukemia Service Sites and Acute Leukemia Service Sites shall provide mentorship (e.g., onsite training, sharing resources, availability to respond to questions, etc.) to affiliated Acute Leukemia Shared-Care Partner Centres, Systemic Treatment Hospitals, and other centres, as appropriate [2]. 1 |
1.8 | The Clinical Program shall have a designated acute leukemia team that includes a Clinical Program Medical Director, a Quality Manager, and a total of at least three (3) full-time attending hematologists 2 providing 24 h coverage (including by phone) [2,11,17]. 1 |
1.8.1 | Shared-care centres shall have access to acute leukemia expertise through an Acute Leukemia Service Site [2]. 3 |
1.9 | The Centre shall collaboratively participate in provincial capacity management activities (e.g., CritiCall Ontario), as needed, to ensure access to timely care [2,14]. |
1.10 | The Centre should provide clinical services for patients with hematological cancers delivered by multidisciplinary hemato-oncology teams [11]. |
1.11 | The Centre should provide intensive induction therapy (including induction therapy following remission and subsequent relapse) or less intensive therapy with the intent of remission to a minimum of 10 patients with acute leukemia per year and who are at risk of more than 7 days of neutropenia (absolute neutrophil count of 0.5 × 109/litre or lower) [11,14]. 1 |
CLINICAL UNIT—INPATIENT | |
2.1 | The Centre shall have an ICU or readily available access to an ICU [2,11]. |
2.2 | The Centre shall provide patients who have acute leukemia and are at risk of more than 7 days of neutropenia (absolute neutrophil count of 0.5 × 109/litre or lower) with an inpatient room with an occupancy of no greater than two (2) patients. The room should be equipped with its own bathroom [11,14]. |
2.2.1 | If patients require isolation in accordance with local infectious disease practices, the patient shall be isolated in a private room with a private bathroom [14]. |
2.3 | The Centre shall have a designated inpatient unit that minimizes airborne microbial contamination, in keeping with the Guideline for the Implementation of Air Standards in Ontario [18]. |
2.4 | The Centre shall ensure that there are beds available in a dedicated ward within the hospital with the capacity to treat the planned volumes of patients, including the availability of a flex bed to allow for the direct, urgent admission of patients being managed on an outpatient basis [11,13]. |
2.5 | The Centre should have the level of staffing required for febrile neutropenia patients that is equivalent to that in a high-acuity unit, as per hospital policies [11]. |
CLINICAL UNIT—OUTPATIENT | |
2.6 | The Centre shall provide monitoring following leukemia therapy in an ambulatory setting and ensure that there is an area for outpatient care that provides the following:
|
2.7 | The Centre should consider ambulatory care for patients who have hematological malignancies that are in remission and other clinically appropriate patients, who are at risk of more than 7 days of neutropenia (absolute neutrophil count of 0.5 × 109/litre or lower) (i.e., outpatient consolidation chemotherapy, other less intensive therapies) [11,13]. |
2.8 | The Clinical Program should account for the following when assessing patients to determine if ambulatory care is appropriate: 2.8.1 Access to appropriate and timely transport 2.8.2 Accommodation and communication facilities 2.8.3 Availability of caregiver to provide support 2.8.4 Comorbidities 2.8.5 Distance and travel times to treatment in case of neutropenic fever and other toxicities 2.8.6 Patient’s and/or caregivers’ understanding of the safety requirements of ambulatory care and their individual treatment plan 2.8.7 Patient preference [11]. |
CLINICAL UNIT—SUPPORTIVE SERVICES | |
2.9 | The Centre shall have an on-site blood bank with the ability to deliver packed red blood cells and platelet transfusions, as well as plasma and factor concentrates, without delay [2,11]. |
2.9.1 | The Centre’s blood bank should have a record of patient transfusions that is accessible to the members of the multidisciplinary Clinical Program [14]. |
2.10 | The Centre shall have 24 h access to irradiated blood products needed for the care of acute leukemia patients as per the National Advisory Committee on Blood and Blood Products—Recommendations for use of Irradiated Blood Components in Canada, 2018, or as updated [19]. |
2.11 | The Clinical Program shall have dedicated pharmacists with oncology/hematology training involved in the inpatient and outpatient care of leukemia patients [2,11]. |
2.12 | The Centre shall have 24 h availability of medications needed for the care of acute leukemia patients [17]. |
2.13 | The Centre shall have appropriate diagnostic services to care for the acute leukemia patient population and complications of therapy, including, but not limited to, bronchoscopy, cross-sectional imaging, endoscopy, and renal support [11,14]. |
2.14 | The Centre shall have access to expertise and supporting technologies for image-guided biopsy and interventional radiology/oncology [14]. |
2.15 | The Centre shall have access to leukapheresis therapy [20]. |
2.16 | The Centre should have expertise in vascular access for central venous catheter insertions [11]. |
PERSONNEL | |
3.1 | The Clinical Program shall include members of a multidisciplinary care team (which may include Clinical Associates, Nurse Practitioners, Physician Assistants, Registered Nurses, and other providers) with the appropriate training and oversight by a hematologist/oncologist [13]. |
3.1.1 | The scope of responsibility of the multidisciplinary care team members shall be defined [17]. |
3.1.2 | The Clinical Program Team (Physicians/Pharmacists/Nurse Practitioners/Physicians’ Assistants/Clinical Associates) shall participate in a minimum of ten (10) hours of educational activities (e.g., self-directed education, rounds, webinars, meetings, conferences) annually, related to acute leukemia care or management [17]. |
CLINICAL PROGRAM MEDICAL DIRECTORS | |
3.2 | The Clinical Program Medical Director shall have at least two (2) years of experience as an attending physician responsible for the direct clinical management of acute leukemia patients in the inpatient and outpatient settings [17]. 1 |
3.3 | The Clinical Program Medical Director shall have oversight of the medical care provided by all members of the Clinical Program [17]. |
3.4 | The Clinical Program Medical Director or designate shall be responsible for verifying the knowledge and skills of members of the Clinical Program multidisciplinary care team, including nurses, pharmacists, physicians, and other providers once every three (3) years [17]. |
3.5 | Working in partnership with hospital administration, the Clinical Program Medical Director shall be responsible for administrative and clinical operations, including compliance with these recommendations and applicable laws and regulations [17]. |
3.6 | Working in partnership with hospital administration, the Clinical Program Medical Director shall be responsible for all elements of the design of the Clinical Program including quality management as per Section D.4, whether internal or contracted services, which may be part of a broader malignant hematology program [17]. |
CLINICAL PROGRAM MEDICAL DIRECTORS AND ATTENDING PHYSICIANS | |
3.7 | Clinical Program Medical Directors and Attending Physicians shall have received specific training in each of the following areas as applicable to the Clinical Program’s services: 3.7.1 Applicable regulations and reporting responsibilities for adverse events and reactions, as required by Health Canada [17]. 3.7.2 Documentation and reporting for patients on investigational protocols and completion of Good Clinical Practice training as recognized by their institution [35]. |
ATTENDING PHYSICIANS | |
3.8 | Attending Physicians shall have received specific training in each of the following areas as applicable to the Clinical Program’s services: 3.8.1 Administration of acute leukemia therapy 3.8.2 Blood transfusion management 3.8.3 Cardiac dysfunction 3.8.4 Diagnosis and management of fungal disease 3.8.5 Diagnosis and management of infectious and non-infectious complications of acute leukemia therapy, including, but not limited to: 3.8.5.1 Appropriate antimicrobial prophylaxis 3.8.5.2 Hemophagocytosis 3.8.5.3 Hypersensitivity reactions 3.8.5.4 Management of neutropenia and neutropenic fever 3.8.5.5 Management of mucositis, nausea, and vomiting 3.8.5.6 Management of thrombocytopenia and bleeding, including recognition of disseminated intravascular coagulation 3.8.5.7 Monitoring and management of pain 3.8.5.8 Neurologic toxicity 3.8.5.9 Renal dysfunction 3.8.5.10 Respiratory distress 3.8.5.11 Tumour lysis and cytokine release syndrome 3.8.6 Evaluation of post-leukemia therapy outcomes and late effects 3.8.7 Goals of care 3.8.8 Indications and appropriateness of leukemia therapy, including appropriate selection of suitable candidates for HCT or cellular therapy referral 3.8.9 Palliative and end-of-life care 3.8.10 Survivorship care 3.8.11 Use of irradiated blood products, where appropriate [14,17]. |
3.9 | Attending physicians shall each have had a minimum total of one (1) year of supervised training in the management of acute leukemia patients in both inpatient and outpatient settings [17]. |
PHYSICIANS’ ASSISTANTS, CLINICAL ASSOCIATES, NURSE PRACTITIONERS, AND REGISTERED NURSES | |
3.10 | Physicians’ Assistants, Clinical Associates, Nurse Practitioners, and Registered Nurses shall have received specific training and maintain competence in the acute leukemia-related skills that they routinely practice within their respective role including: 3.10.1 Administration of acute leukemia therapy 3.10.2 Administration of blood products, growth factors, and other supportive therapies 3.10.3 Care interventions to manage acute leukemia therapy-related complications, including, but not limited to: 3.10.3.1 Cardiac dysfunction 3.10.3.2 Cytokine release syndrome 3.10.3.3 Disseminated intravascular coagulation 3.10.3.4 Hypersensitivity reactions 3.10.3.5 Infectious processes 3.10.3.6 Mucositis 3.10.3.7 Nausea and vomiting 3.10.3.8 Neurologic toxicity 3.10.3.9 Neutropenic fever 3.10.3.10 Pain management 3.10.3.11 Renal and hepatic failure 3.10.3.12 Respiratory distress 3.10.3.13 Tumor lysis syndrome 3.10.4 Palliative and end-of-life care 3.10.5 Survivorship care [2,14,17]. |
3.11 | The Clinical Program shall have a sufficient number of nurses, based on number of patients and acuity, appropriately trained in the care of acute leukemia patients [17,21]. |
3.12 | The Clinical Program should have specialized oncology nurses with national certification in oncology through the Canadian Nurses Association and additional knowledge, clinical skills, and clinical decision-making in leukemia (such as training from the de Souza institute) [7]. |
PHARMACISTS | |
3.13 | Training and knowledge of designated pharmacists shall include: 3.13.1 Requirements detailed in the Regional Models of Care for Systemic Treatment: Standards for the Organization and Delivery of Systemic Treatment, as appropriate to their designated level of service [7,14]. 3.13.2 Hematology/oncology patient care, including the role of, administration of, and complications of systemic therapy for acute leukemia patients [17]. 3.13.3 Monitoring for and recognition of drug/drug and drug/food interactions and necessary dose modifications [17]. 3.13.4 Recognition of medications that require adjustment for organ dysfunction [17]. 3.13.5 Therapeutic drug monitoring, including, but not limited to, anti-infective agents, immunosuppressive agents, anti-seizure medications, and anticoagulants [17]. |
3.14 | Clinical pharmacists, or designate, shall work with the multidisciplinary team to perform medication reconciliation, monitor for side effects, including medication side effects, and provide supportive care and manage symptoms [2]. |
OTHER SPECIALISTS | |
3.15 | The Clinical Program shall have access to certified or trained consulting specialists and/or specialist groups from key disciplines capable of assisting in the management of acute leukemia patients, including, but not limited to: 3.15.1 Cardiology 3.15.2 Dentistry 3.15.3 Dermatology 3.15.4 Gastroenterology 3.15.5 Infectious Disease 3.15.6 Intensive Care 3.15.7 Nephrology 3.15.8 Neurology 3.15.9 Obstetrics/Gynecology 3.15.10 Ophthalmology 3.15.11 Pain and Symptom Management 3.15.12 Palliative and End-of-Life Care 3.15.13 Pathology and Hematopathology (including molecular diagnostics and genetics) 3.15.14 Physiatry/Rehabilitation Medicine 3.15.15 Psychiatry 3.15.16 Pulmonary Medicine 3.15.17 Radiology, including relevant subspecialty expertise related to: 3.15.17.1 Cross-sectional Imaging 3.15.17.2 Interventional Radiology 3.15.18 Radiation Oncology 3.15.19 Surgical services that includes general surgery, thoracic, neurosurgery, and ears, nose, and throat (ENT) surgery 3.15.20 Transfusion Medicine [2,14,17]. |
3.16 | The Clinical Program shall have access to a multidisciplinary care team, including designated staff with appropriate training and education, to assist in the provision of pre-treatment evaluation, treatment, and post-treatment follow-up and care. Designated staff/roles shall include: 3.16.1 Data management staff sufficient to comply with Sections titled ‘Data Management’ and ‘Laboratory Services’ 3.16.2 Decision-support resources to collate and analyze quality indicators 3.16.3 Dietitian 3.16.4 Interpretative/translation services 3.16.5 Patient care coordinator 3.16.6 Physical therapy and occupational therapy 3.16.7 Psychology 3.16.8 Social work 3.16.9 Speech language pathology 3.16.10 Spiritual care 4 [2,14,17]. |
QUALITY MANAGERS | |
3.17 | There shall be a Clinical Program Quality Manager to establish and maintain systems to review, modify, and approve all policies and SOPs intended to monitor compliance with these recommendations or the performance of the Clinical Program [17]. |
3.18 | The Clinical Program Quality Manager shall participate in a minimum of ten (10) hours of educational activities (e.g., self-directed education, rounds, webinars, meetings, conferences), annually, related to acute leukemia therapy and/or quality management [17]. |
QUALITY MANAGEMENT | |
4.1 | Centres shall have a Quality Management Program that allows the Clinical Program Medical Director and all members of the care team to maintain their competency as internally assessed by the Clinical Program Medical Director or designate. The clinical competency of the Clinical Program Medical Director should be assessed by another identified staff member [17]. |
4.1.1 | The Clinical Program Medical Director or designate shall have authority over and responsibility for ensuring that the overall Quality Management Program is effectively established and maintained [11,17]. |
4.1.2 | The Clinical Program Medical Director or designate shall review the Quality Management activities with representatives in key positions in all elements of the Clinical Program, at a minimum, quarterly [17]. |
4.1.2.1 | Key performance data and review findings shall be reported to staff [17]. |
4.1.2.2 | Meetings should have defined attendees, documented minutes, and assigned actions [17]. |
4.1.2.3 | In the course of their regular meetings, the Clinical Program should annually review patient feedback of the acute leukemia program and any actions implemented, and improvement programs [22]. |
4.1.3 | The Clinical Program Medical Director or designate shall annually review the effectiveness of the overall Quality Management Program [17]. |
4.1.4 | The Clinical Program Medical Director or designate shall not have oversight of his/her own work if this person also performs other tasks in the Clinical Program [17]. |
4.2 | The Clinical Program shall establish and maintain a written Quality Management Plan [17]. |
4.2.1 | The Clinical Program Medical Director or designate shall be responsible for the Quality Management Plan [17]. |
4.2.2 | The Quality Management Plan shall include, or summarize and reference, a comprehensive system for document control [17]. |
4.2.2.1 | There shall be policies or SOPs for the development, approval, implementation, distribution, review, revision, and archival of all critical documents [17]. |
4.2.3 | The Quality Management Plan shall include, or summarize and reference, policies and SOPs for the establishment and maintenance of written agreements [17]. |
4.2.3.1 | Agreements shall be established with external parties (who are accredited, as appropriate) providing critical services that could affect the quality and safety of care for patients in the Clinical Program [17]. |
4.2.3.2 | Agreements shall be dated and reviewed on a regular basis [14]. |
4.2.4 | The Quality Management Plan shall include, or summarize and reference, policies and SOPs for occurrences including near misses, errors, accidents, deviations, adverse events, adverse reactions, and complaints. This may be the same as existing policy at the centre [17]. |
4.2.5 | The Quality Management Plan shall include, or summarize and reference, policies and SOPs for actions to take in the event that the Clinical Program’s operations are interrupted [17]. |
4.2.6 | The Quality Management Plan shall include, or summarize and reference, policies and SOPs for qualification of critical manufacturers, vendors, equipment, supplies, reagents, facilities, and services [17]. |
4.2.6.1 | Qualification plans, results, and reports shall be reviewed and approved by the Quality Manager and Clinical Program Medical Director or designate [17]. |
4.2.7 | The Quality Management Plan shall include, or summarize and reference, policies and SOPs for the evaluation of risk in changes to a process to confirm that the changes do not create an adverse impact or inherent risk elsewhere in the operation [17]. |
4.2.8 | The Quality Management Plan shall include, or summarize and reference, an organizational chart of key positions and functions within the Clinical Program (governance structure) [17]. |
4.2.8.1 | The Quality Management Plan shall include a description of how these key positions interact to implement the quality management activities [17]. |
4.2.8.2 | The Quality Management Plan shall include, or summarize and reference, policies and SOPs addressing personnel requirements for each key position in the Clinical Program. Personnel requirements shall include at a minimum: |
4.2.8.2.1 | A current job description for all staff [17]. |
4.2.8.2.2 | A system to document the following for all staff:
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4.2.9 | The Quality Management Plan shall include key performance indicators and outcome analysis [14]. |
4.2.9.1 | The Clinical Program should work with Ontario Health (Cancer Care Ontario) to meet Provincial Acute Leukemia Program benchmarks, including: 4.2.9.1.1 Consult Wait Times 4.2.9.1.2 Length of stay 4.2.9.1.3 Mortality 4.2.9.1.4 Survival Outcomes 4.2.9.1.5 Treatment Utilization 4.2.9.1.6 Treatment Wait Times, and 4.2.9.1.7 Other indicators, as established [14]. |
4.2.9.2 | In addition to the Ontario Health (Cancer Care Ontario) recommended metrics, review of outcome analysis shall include at a minimum: 4.2.9.2.1 Central venous catheter infection and/or thrombosis 4.2.9.2.2 Complete remission 4.2.9.2.3 Hospital acquired infections 4.2.9.2.4 ICU admissions [14,17]. |
4.2.10 | The Quality Management Plan shall include, or summarize and reference, policies and SOPs for, and a schedule of, audits of the Clinical Program’s activities to verify compliance with elements of the Quality Management Program and policies and SOPs, applicable laws or regulations, and these Specifications [17]. |
4.2.10.1 | The results of audits shall be used to recognize problems, detect trends, identify improvement opportunities, and implement corrective and preventive actions, when necessary, and follow up on the effectiveness of these actions in a timely manner [17]. |
4.2.10.2 | Audits shall be conducted by an individual with sufficient expertise to identify problems, but who is not solely responsible for the process being audited [17]. |
POLICIES AND PROCEDURES | |
5.1 | The Centre shall have SOPs that are detailed, as per hospital’s policy, to allow qualified staff to follow and complete the procedures successfully [14]. |
5.2 | The Clinical Program shall have SOPs defining local protocols for patient eligibility and selection for care (including performance status, prognostic factors, comorbidities) and consent [11,17]. |
5.3 | There shall be written SOPs or guidelines, including, but not limited to: 5.3.1 All clinical procedures 5.3.2 Administration of systemic therapy 5.3.3 Central venous access device care 5.3.4 Management of complications with systemic therapy: 5.3.4.1 Nausea, vomiting, pain, and other discomforts 5.3.4.2 Monitoring of blood counts and transfusion of blood products 5.3.4.3 Monitoring and management of infections and use of antimicrobials 5.3.4.4 Monitoring of organ dysfunction or failure 5.3.5 Prophylaxis, management and care of immunocompromised patients [11,14,17,23]. |
5.4 | The Centre shall have policies addressing safe administration of patient-specific radiation therapy [24]. |
5.5 | The Clinical Program shall have policies or SOPs in place for planned discharges and provision of follow-up care post-systemic therapy care, including transfer of patient, if required [17]. |
5.6 | The Clinical Program shall have a SOP for inter-institutional patient transfer that specifies clinical criteria for eligibility to transfer the patient and information transferred with the patient [14]. |
5.7 | The Clinical Program shall have an SOP for electronic decision-making tools used by the Clinical Program documenting the tools development, validation, and auditing [14]. |
5.8 | Staff training and, if appropriate, competency shall be documented before performing a new or revised SOP or guideline [17]. |
5.9 | Planned deviations from SOPs shall be pre-approved by the Clinical Program Medical Director, or designate, and reviewed by the Quality Manager [17]. |
5.10 | The Centre should have a SOP for the recognition of systemic therapy-related complications and emergencies requiring rapid notification of the Clinical Program [17]. |
5.11 | The Centre should have an institutional SOP for direct admission of patients to the hematology ward or other facilities equipped to rapidly assess and manage potentially life-threatening complications of systemic therapy (such as neutropenic sepsis or bleeding), where appropriate [11]. |
5.12 | The Clinical Program should have an established framework or policies for the transfer of patients to the ICU, as appropriate. The framework/policies should include written guidelines for communication, patient monitoring, and prompt triage or transfer of patients to an ICU when appropriate [17,25]. |
5.13 | The Centre should have written policies for communication with the person’s primary care physician and other teams involved in treatment [11]. |
PATIENT CARE | |
6.1 | The Clinical Program shall obtain patient informed consent, as per Accreditation Canada, for systemic therapy, which is documented in the patient’s medical record by a licensed health care professional familiar with the proposed systemic therapy [7,14]. |
6.1.1 | The Clinical Program shall provide information regarding the risks, benefits, and alternatives of the proposed systemic therapy [17]. |
6.1.2 | The Centre shall provide the patient with information regarding the impact of treatment on fertility and information, including contact information, about fertility preservation [14]. |
6.2 | The Centre shall provide the patient with access to active palliative care, supportive end-of-life care [26], and medical assistance in dying (MAID) [27]. In accordance with patient and family’s wishes, this care could be provided at centres at and beyond the acute leukemia service provider sites and can be offered closer to home [2]. |
6.3 | If radiation is used, the centre shall document a final report with details of the radiation therapy administered in the patient’s medical record that is accessible to the acute leukemia team [17]. |
6.4 | The Clinical Program shall provide services for adolescents and young adult patients and a process describing the transition and acceptance of adolescents and young adult patients to adult care, as appropriate [12,17]. |
6.5 | The Centre should provide formal Multidisciplinary Case Conferences (MCC), where acute leukemia cases may be presented and discussed, attended by individuals detailed in the Cancer Care Ontario’s MCC Standards [11,28]. |
6.6 | The Clinical Program should provide acute leukemia patients with access to a designated contact person, as part of a multidisciplinary team, throughout the duration of their care [29]. |
6.7 | The Centre should provide care in alignment with Cancer Care Ontario’s Person-Centred Care Guidelines [30], in efforts to meet the Person-Centred goals and objectives detailed in the most recent version of the Ontario Cancer Plan [31]. |
CLINICAL RESEARCH | |
7.1 | The Centre shall conduct and/or provide access to clinical trials and consider available clinical trials when assessing patient treatment options [2,22]. 1 |
7.2 | The Centre shall report available clinical trials for patients with acute leukemia to Ontario Health (Cancer Care Ontario) (by emailing [email protected]) or a central repository to inform other centres of their availability [14]. 1 |
DATA MANAGEMENT | |
8.1 | The Centre shall be compliant with laws and regulations regarding the storage and use of personal health information as detailed by the Information and Privacy Commissioner of Ontario [14,15]. |
8.2 | The Centre shall be compliant with the Cancer Care Ontario Data Book [2]. |
8.3 | The Clinical Program shall collect all the data necessary to complete data submission requirements of Ontario Health (Cancer Care Ontario), as detailed in the Funding Agreement with Ontario Health (Cancer Care Ontario) [14]. |
8.4 | The Clinical Program should have an IT system that allows: 8.4.1 Specimen booking and registration at source 8.4.2 Input and update of clinical information 8.4.3 Integrated/synoptic reporting 8.4.4 Secure internal and external two-way communication between health care professionals [11]. |
8.5 | Defined data management staff should participate in continuing education annually [17]. |
LABORATORY SERVICES | |
9.1 | The Centre shall ensure that patients have access to all required pathology and molecular diagnostic tests as listed in the most recent version of the Consensus Pathology Recommendation for Complex Malignant Hematology Report [24]. |
9.1.1 | Testing sites shall meet all relevant Institute for Quality Management in Healthcare requirements and maintain Institute for Quality Management certification [14]. |
9.1.2 | All testing performed for clinical management should be licensed and performed by accredited labs [14]. |
9.1.3 | Testing sites performing cytogenetics and molecular diagnostics shall meet provincial turnaround time targets [32]. |
9.2 | The Centre shall classify and report acute leukemia and subtypes based on the current World Health Organization classification system and Ontario Health (Cancer Care Ontario) Synoptic Reporting, when in place [11,32,33]. |
5. Discussion
5.1. Strengths and Limitations
5.2. Next Steps and Future Directions
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgements
Conflicts of Interest
References
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Service Site | Services Provided |
---|---|
Transplant and Acute Leukemia Service Site | Provides the full scope of acute leukemia services and stem cell transplant. These sites may also provide chimeric antigen receptor T-cell (CAR T-cell) therapy. The Transplant and Acute Leukemia Service Site acts as the hub of activity for patients with complex hematologic malignancies. Across the province, these centres work together to ensure a standardized approach across the care continuum. |
Acute Leukemia Service Site | Provides the full scope of acute leukemia services, including intensive induction therapy and less intensive therapy, with the intent of achieving remission and disease control, as well as post-remission treatment and care. The Acute Leukemia Service Sites do not perform stem cell transplant or CAR T-cell therapy but instead work with the Transplant Sites to ensure that their patients have access to these services. They may also work with Transplant Sites to accept autologous stem cell transplant patients for post-transplant recovery closer to home. The Acute Leukemia Service Site may partner with an Acute Leukemia Shared Care Partner Centre and/or other systemic treatment hospitals to support care closer to home. |
Acute Leukemia Shared-Care Partner Centre | Provides a subset of services for patients through a shared-care model. Partner centres work with an Acute Leukemia Service Site, or a Transplant and Acute Leukemia Service Site, to share portions of care on an ongoing basis and/or accept autologous transplant patients for post-transplant recovery closer to home. |
Population | Adults (Defined as ≥ 18 Years of Age) Canada, the United States, the United Kingdom, Australia, Europe |
---|---|
Disease Type | Acute leukemia, Acute Myeloid Leukemia (AML), Acute erythroblastic leukemia, acute myelomonocytic leukemia, hematology Exclusion: angiomyolipoma, cord blood, venous thromboembolism, lupus |
Study Designs | Guideline, recommendations, standards, organizational standards, practice guidelines, practice parameters, consensus standards, systematic review |
Study Characteristics and Timeline | Exclusion: clinical trial, randomized clinical trial English language, published within the previous 10 years of the search date (2007–2017) |
Shall | to be complied with at all times |
Should | an activity is recommended or advised, but for which there may be appropriate alternatives |
May | permissive and is used primarily for clarity |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Verville, L.; McKay, C.; Kouroukis, T.; Apostolovski, S.; Sabloff, M.; Buckstein, R.; Kennedy, K.; Yee, K.; Eakins, A.; Bredeson, C. Developing Organizational Requirements to Standardize Delivery and Improve Quality of Acute Leukemia Care in Ontario. Curr. Oncol. 2024, 31, 4656-4674. https://doi.org/10.3390/curroncol31080347
Verville L, McKay C, Kouroukis T, Apostolovski S, Sabloff M, Buckstein R, Kennedy K, Yee K, Eakins A, Bredeson C. Developing Organizational Requirements to Standardize Delivery and Improve Quality of Acute Leukemia Care in Ontario. Current Oncology. 2024; 31(8):4656-4674. https://doi.org/10.3390/curroncol31080347
Chicago/Turabian StyleVerville, Leslie, Cassandra McKay, Tom Kouroukis, Suzanna Apostolovski, Mitchell Sabloff, Rena Buckstein, Kardi Kennedy, Karen Yee, Amanda Eakins, and Christopher Bredeson. 2024. "Developing Organizational Requirements to Standardize Delivery and Improve Quality of Acute Leukemia Care in Ontario" Current Oncology 31, no. 8: 4656-4674. https://doi.org/10.3390/curroncol31080347