Influence of audit on clinical practice: multidisciplinary team data documentation for cutaneous head and neck malignancy

Abstract

Background: Prognosis of cutaneous head and neck malignant neoplasms is related to type, site, and histologic feature but may also be influenced by delays in the referral process. Treatment aims to address the primary lesion and when necessary the secondary disease but at the same time maintaining quality of life and minimizing cosmetic deformity. The management plan should ideally be the "product" of a multidisciplinary team (MDT) approach of dermatologists, surgeons, oncologists, pathologists, and radiologists.

Aims: The purposes of the study were as follows: (i) to review current documentation practice of cutaneous head and neck malignancies in a district hospital, (ii) to generate an MDT-approved data collection proforma, and finally (iii) to reaudit documentation of head and neck skin lesions based on the "new" standardized proforma. The MDT-approved proforma was instituted in an effort not only to collect data in a coherent and structured way but also to achieve early diagnosis and avoid delays from urgent referral to treatment with the aim of curing disease and restoring patients to as near-normal appearance and quality of life as possible.

Methods: The notes of patients with head and neck cutaneous lesions were prospectively audited for a 6-month period (August 2006-January 2007). The presence and absence of a minimal standardized data set required for MDT discussion and review were recorded.

Results: Documentation was deficient and a need for change in practice emerged. An MDT-approved data collection standardized proforma was designed and distributed throughout the hospital departments involved in management of patients with head and neck cutaneous lesions. The notes of these patients were prospectively reaudited through a second cycle for a 6-month period (February 2007-August 2007). The completion and deficiency of sections of the MDT-approved data collection standardized proforma were recorded, resulting in closure of the audit loop.

Conclusions: The data documentation for head and neck cutaneous lesions has significantly improved after the implementation of an MDT-approved data collection standardized proforma. This has resulted in improved patient quality of care and progression on appropriate management plans.