Division of Cancer Surgery Information Guide

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1 Division of Cancer Surgery Information Guide Professor Sandy Heriot Director - Division Cancer Surgery Professor Michael Henderson Deputy Director Division Cancer Surgery Executive Sponsor Education and Training Overview Welcome. 2 Multidisciplinary Care 2 Training & Teaching...3 Research. 4 Patient Journey..5 Important Forms....8 Page 1 January 2015

2 Welcome Welcome to your surgical oncology term. We really hope you ll enjoy the term. It will give you a unique insight into surgical oncology as well as exposure both in theatre and the ward of dealing with surgical patients undergoing cancer-related treatment. The following guide is designed to give you a brief overview of the Department of Surgical Oncology, your roles and responsibility as well as giving you some information about the running of the team. The Department of Surgical Oncology has three core roles:- 1. Multidisciplinary Care 2. Training and Teaching 3. Research 1. Multidisciplinary Care The management of the surgical oncology patient is complex and requires input and care from a variety of aspects. For many patients, surgery only makes up one facet of their treatment and therefore it is important that the entire treatment plan is designed prior to beginning treatment. This often requires numerous investigations and multidisciplinary discussions. We believe it is important to provide a holistic approach to care which address all the physical, psychological and social aspects of our patients treatment. There is a big team required to provide all these aspects of care and you will need to work within that structure and understand who can help with what. Our tumour stream nurse co-ordinators play the pivotal role in this approach to cancer care and they are also a fantastic resource. Sarah Pratt Breast Care Nurse Coordinator Page 2 January 2015 Meg Rogers Clinical Services Coordinator - GI Service

3 Donna Milne Nurse Coordinator Skin & Melanoma Service Carolyn Atkin & Joan Donohue Stomal Therapy Nurse Consultants 2. Training and Teaching The case-load at Peter Mac is different from many other hospitals given the unique focus on cancer and the referral of complex patients. Although you are not always expected in theatre, you are very welcome to attend at any time. It is important to plan the days that you wish to attend theatre and arrange cover. Please ensure you understand the indication and type of surgery. The more effort you put in prior to your visit to theatre, the more you will get out of it. There are many interesting operations occurring at Peter Mac every week some of which you may not have the opportunity to see elsewhere. There is also a huge amount of interesting reconstruction performed by the plastic surgical team which you should attempt to see during your term. Peter MacCallum is the only public hospital in Australia with a DaVinci robot so you should take the opportunity to see it in action. Page 3 January 2015

4 There is a busy and exceptional Academic program here at Peter Mac that you should make sure you take advantage of. Department of Surgical Oncology Meeting - Wednesday morning 7:30 Alternating on a four week roster there is an academic, translational, quality assurance and audit presentation every week. Punctual attendance at this meeting is mandatory. Seminars in Oncology Regular lectures are run by the research department in the Level 3 lecture theatre. You will receive s about these sessions and you are encouraged to attend. HMO Educational Session Friday lunchtime 1pm range of presenters. This is mandatory and you will not be paged during this session. Unit MDMs Each cancer stream has a specific weekly MDM. These are a great educational meeting which you should try and attend as frequently as possible. Most will have an academic program attached for example there is a half hour academic presentation after the melanoma MDM on Friday mornings or prior to the Breast MDM on Friday lunchtime. Speak to the individual tumour stream registrars for the MDM timetable for that unit. On Wednesday morning Professor Henderson does a ward round with the senior nurse and the residents. You are expected to attend this teaching round. Medical students attend Peter Mac throughout the year. Please make them welcome and get involved in their training. 3. Research Page 4 Surgical Oncology Research Laboratory team January 2015

5 Page 5 January 2015

6 Peter MacCallum houses the largest cancer research centre in Australia. As such there is a very strong research presence within the Department of Cancer Surgery. There are a broad range of potential research projects in a variety of tumour streams. The projects will be supervised by an experienced consultant and expedited ethics review can be facilitated to allow timely commencement of the project. A presentation at a national/international conference and publication in an appropriate journal is the expectation for research projects undertaken within the Division. There are a number of surgical trainees taking time out of their training to complete a post-graduate research degree at Peter Mac. If you are considering this, they are a valuable resource. For a list of ready-to-go research projects (clinical-based), or to discuss undertaking full time research at Peter Mac please speak to Mr David Gyorki For information on Laboratorybased research projects, please contact Professor Wayne Phillips on extension The Patient Journey Multidisciplinary Meetings (MDM) The MDM s are attended by a broad range of specialists - surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, nurse coordinators, dieticians, geneticists etc. They are important forums for discussion and formulation of individualised treatment plans. Outpatient Clinic Clinics are tumour streamed based and are attended by a range of people from surgeons, oncologists, nurse co-ordinators, allied health staff and clinic nurses. Most patients will be consented for theatre in outpatients and this requires both the: o Theatre booking form, and o HAQ (health assessment questionnaire) form to be completed There is a fantastic pre-operative anaesthetic service who can provide CPX or pre-hab for patients if required. Please be aware the hospital has a QUIT program for patients and this should be offered to patients when appropriate. Consent (see forms at end of this document) Consent should be completed by the treating surgeon, fellow or registrar. This is not the responsibility of the HMO. Page 6 January 2015

7 When seeing patients pre-operatively in day surgery, it is important to ensure the consent is signed, the procedure is verified and the site marked. Patients without appropriate markings will not be taken to the holding bay. Theatre There are five (5) operating theatres which usually run all day. Your attendance in theatre is strongly encouraged. Theatre 1 has major laparoscopic capability with inbuilt laparoscopic screens. Theatre 4 is the dedicated radiotherapy theatre and Theatre 3 is usually where the robotic cases happen. When coming to theatre ensure you are aware of the patient s history and if possible examine the patient pre-operatively. The more you put in, the more you will get out of it! We very much encourage you to come to theatre but you need to ensure your ward jobs are completed and your pager handed to another HMO to cover. Please let the ward staff know where you are and how to contact you if needed in an emergency. Ward The bulk of your responsibilities are on the ward and your organisational skills are critical to the functioning of the hospital. Ward Rounds You are expected to help the tumour stream fellow and registrar with documenting and communicating the daily management plan for the patients to the nursing staff and allied health staff. The documentation needs to be legible and sensible. Ensure that the ANUM is updated about any significant changes to the patient s plans. As you cover more than one tumour stream you might not be able to be on every ward round every day. Please make sure the registrar or fellow updates you if they have done the round without you. In the afternoons most teams will do a round before they leave hospital for the day. This is your opportunity to update the registrar/fellow/consultant on the patient s progress and discuss any issues. Discharging patients Discharge planning is a crucial part of ward care and you are expected to take an active role in this. Please make sure all discharge paperwork is completely in a timely fashion as not to delay discharges. Please be mindful that Peter Mac does not have a pharmacist rostered for the weekend so if you know a patient will be discharged on the weekend try to have their discharge medication sorted out on Friday before they go. Inpatient Referrals Try and make your inpatient referrals as early in the day as possible so the referring team has maximum time to review the patient during that day. Page 7 January 2015

8 NFR Status It is your responsibility to ensure this is accurately documented. If you have any queries about a patient s status make sure you clarify this with the appropriate registrar or fellow. Admission Patient admissions take up a large proportion of your ward work. For Post operative patients it is a vital time to check:- o Wounds o Past history and any unaddressed issues o Regular medications o Allergies o Thromboprophylaxis plan (STEP protocol) o Analgesia o Allied health referrals o Unaddressed social issues o Discharge plan It is very important to urgently contact the surgical team if you are concerned about a post operative patient. The consultants are very happy to be contacted any time of day or night if you are worried. Pathology It is your responsibility to order bloods for our patients. Please be sensible about this and it is best to ask the treating team s registrar or fellow about what bloods to order if you are unsure. Unnecessary ordering of tests is costly and painful for patients. Weekends Each tumour stream will attend a ward round every day. There is only one of you so make sure you know the plan from each team as there will often be clashes of ward rounds. There is a registrar on call who should be your first point of contact for any patient you are concerned about over the weekend. Discharge summaries Discharge summaries are an important part of communication and recording a patient s inpatient stay and any complications. Although they can be tedious they are in fact a very import document and appropriate thought and time should be spent completing them. It is important to record complications as this will assist the hospital coders. For short admissions it is worthwhile completing a little each day in the summary. Page 8 January 2015

9 Important forms Page 9 January 2015

10 Page 10 January 2015

11 Page 11 January 2015

12 Page 12 January 2015

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