P75: “Next Gen” Operative Notes – synoptic operative reporting for cancer surgery

Thursday, March 23, 2023

3:51 PM – 3:56 PM

Location: SSO HUB: Rare/Metastatic Cancers Zone

Poster Presenter(s)

William R. Burns, MD (he/him/his)

Section of Hepatobiliary and Pancreatic Surgery
The Johns Hopkins Department of Surgery
Baltimore, Maryland, United States

Disclosure information not submitted.

Author(s)

William R. Burns, MD (he/him/his)

Section of Hepatobiliary and Pancreatic Surgery
The Johns Hopkins Department of Surgery
Baltimore, Maryland, United States

Disclosure information not submitted.
Tina J. Hieken, MD

Professor of Surgery
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
LZ

Linda Zheng, BS

Cancer Surgery Standards Program
American College of Surgeons, United States

Disclosure information not submitted.
AF

Amanda B. Francescatti, MS

Cancer Surgery Standards Program
American College of Surgeons, United States

Disclosure information not submitted.
Mediget Teshome, MD, MPH, FACS (she/her/hers)

Associate Professor
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure(s): Endomagnetics: Other (Terminated)
TV

Timothy Vreeland, MD

Department of Surgery
San Antonio Military Medical Center, United States

Disclosure information not submitted.
AM

Arden M. Morris, MD, MPH

Department of Surgery
Stanford University School of Medicine, United States

Disclosure information not submitted.
KS

Kristan L. Staudenmayer, MD, MS

Department of Surgery
Stanford University School of Medicine, United States

Disclosure information not submitted.
Kelly K. Hunt, MD (she/her/hers)

Chair, Department of Breast Surgical Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure(s): Armada Health: Advisor (Ongoing); Astra Zeneca: Consultant (Ongoing); Cairn Surgical: Research Grant (Ongoing); Eli Lilly & Company: Research Grant (Ongoing); Lumicell: Research Grant (Ongoing)
Matthew HG Katz, MD (he/him/his)

Professor & Chair
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Mediget Teshome, MD, MPH, FACS: Endomagnetics: Other (Terminated)

Kelly K. Hunt, MD: Armada Health: Advisor (Ongoing); Astra Zeneca: Consultant (Ongoing); Cairn Surgical: Research Grant (Ongoing); Eli Lilly & Company: Research Grant (Ongoing); Lumicell: Research Grant (Ongoing)

Matthew HG Katz, MD: No financial relationships to disclose

Introduction: Most pathology and radiology reporting has shifted to synoptic documentation; however, surgeons continue to describe operations in narrative or structured formats that fail to consistently capture and communicate key data. Use of synoptic operative reports (SORs) can simultaneously improve quality and save time. As such, the American College of Surgeons Cancer Surgery Standards Program (CSSP) is developing and implementing SORs for cancer surgery. Here we describe this process, progress to date, and outline future steps of this transition to “Next Gen” operative notes.

Methods: Based on our pilot SOR experience, we developed a comprehensive process (Figure) for generating SORs that document critical elements of cancer surgery, capture billing and coding data, and facilitate efficient surgeon documentation. Subject-matter experts create drafts with content that complies with cancer standards and language that harmonizes with staging, practice guidelines, and administrative needs. Further, SORs feature standardized data elements, response fields, and formatting with a focus on key intraoperative findings and technical details that impact cancer care. Workgroups also develop a “knowledge platform” to provide relevant definitions, clinical standards, supporting evidence and supplemental materials to enhance the SOR. Following secondary review, each SOR and its companion knowledge platform is formatted for integration into electronic medical records.

Results: Expanding on content from the Operative Standards for Cancer Surgery manuals, inclusive teams with at least four members have led SOR development with up to 10 secondary reviewers for each SOR. The pilot SORs, which focused on frequently performed operations for breast cancer, melanoma, and colon cancer, were finalized in 2021. New SORs for thyroid cancer and pancreatic tumors were drafted in 2021 and passed secondary review in early 2022. Lung, gastric, adrenal, sarcoma, and rectal SORs are in development. Therefore, a total of 10 complete SORs are anticipated in the near future. Additional SORs for tumors of the liver, biliary tract, and esophagus will follow. Through cumulative experience and ongoing refinement of the development process, new SORs can be generated concurrently with increased efficiency while efforts for implementation and adoption are ongoing.

Conclusions: Just as synoptic reporting in non-surgical disciplines has improved clinical practice, CSSP efforts to develop ‘Next Gen’ operative notes promise to broadly enhance the delivery of high-quality cancer care.

Learning Objectives:

Upon completion, participant will be able to define synoptic reporting in contrast to narrative and structured reporting.
Upon completion, participant will be able to list benefits of synoptic documentation in clinical practice.
Upon completion, participant will be able to describe the process for development of synoptic operative reports in cancer surgery.