Regional Cancer Centres Forum Ballarat Regional Integrated Cancer

Regional Cancer Centres Forum Ballarat Regional Integrated Cancer Centre (BRICC) Chemotherapy Outreach Stephen Brown: Acting Head of Medical Oncology Steve Medwell: BRICC Director Accountability, Integrity, Collaboration, Compassion, Excellence

Service Provision Considerations � New vs Existing services? ◦ Invitation to support? � Pre existing service to augment, new service build from ground up ◦ Rationale to support? � Activity, capability � Distance (Km’s/hrs) ◦ Victorian hospitals differ from larger states (km’s) ◦ Reliance on certain infrastructure may be reduced (VC, talking heads) ◦ Telehealth � Model of Care/Model of Service ◦ Our experience – patients prefer face to face ◦ Presence – person versus service model ◦ Ownership of service? � Local, VMO or fully labelled as HUB service? ◦ Business System � � Fee for Service Public vs. Private Hub and spoke Time based

Service Provision Considerations � � Sustainability ◦ Adequate Numbers? � Capacity to grow? � Capability to grow? � Large clinic load; 1 full day is marginal as = 12 hrs (OHS) Referral management ◦ Sustainable services? Data (population, patient flows) � Relationships with referrers, existing services ◦ Joint decisions about building the service � Responsibility may be dependent on model of care ◦ Practical requirements of managing a referral – where is it documented; who takes carriage of this?

Service Provision Considerations � � Resource availability in each site? ◦ Specialist Staffing, ICT, OIS? (visibility on information to HUB site) ◦ Pharmacy process? ◦ Allied health ◦ Ward/IP support services (emergency management) IT ◦ ◦ ◦ & Hospital information Systems Use of Hub Oncology system? Paper versus paperless? Hospital EMR system; ADT system, OIS system � At Hamilton, differs across all three ◦ Network settings are crucial if looking to mirror ◦ Travelling staff to see ‘their desktop’ at remote site

Service Provision Considerations � Minimum requirements for Safe Chemo Delivery - general ◦ Overall capability of the service (draft capabilities framework) ◦ Suitable space – defined chemotherapy chairs and treatment rooms ◦ Nursing staff skill ◦ ◦ ◦ � � Day oncology and hospital IP services Medical staff and management Upskilling local services Pharmacy process Peripheral capability (within the outreach site; eg. diagnostic imaging) Medical records management (clinics process; eg. patient review) Safe Prescribing Process - specific ◦ ◦ ◦ Chemotherapy ordering process & signoff Chemotherapy treatment protocols Delivery of drugs Modification to regimens system and version control Patient Consent to treatment Sign-off and redundancy � Availability of medical backfill � Incident review if needed

Service Provision Considerations � Upskilling regional staff (doctors, nurses and supportive care) ◦ Medical model may differ from Hub site ◦ Education for nursing requires protected time and resources at the Hub service ◦ Allied health supports dependant on staffing model of local services � Supportive Care model (holistic model) ◦ SCST, allied health referral, complementary therapy � MDM-MDT: Peer review and team care approach ◦ MDM’s for different regions (BSW versus Grampians) requires significant IT supports ◦ Expectation of MDM-MDT process can differ across services ◦ Prospective vs retrospective � Providing training at the RCC (nursing, supportive and complementary therapy) ◦ As above – resources at the hub need to be considered in business arrangement � Educations sessions – mostly medical staff attending the clinic � Governance structure – monthly meeting to discuss strategy, operations, growth

BRICC Initiatives – Outreach Chemo: consults & treatment; RT consults