Act Locally: Quality and Safety in Head and Neck Care

Every specialty of medicine, including otolaryngology, faces challenges to providing a safer environment for patients. Responding to these challenges will not only improve patient safety, but overall quality of care, as well. – -Kenneth I. Shine, MD

How will 21st-century otolaryngologists meet these challenges? Like all other physicians-by doing the right thing, at the right time, in the right way, for the right person and having the best possible results, according to the Agency for Healthcare Research and Quality (AHRQ).

We, as head and neck surgeons, have to get it right the first time and every time, said Randal S. Weber, MD, Professor and Chairman of the Department of Head and Neck Surgery at University of Texas M.D. Anderson Cancer Center, during his Presidential Address at the 2007 Combined Otolaryngology Spring Meeting. If we fail to control the patient’s head and neck cancer by providing the highest quality of evidenced-based care available, subsequent survival and outcome are negatively impacted.

It is no longer acceptable to be a ‘dabbler,’ described by John M. Lore, MD,ⁱ as one who manages a few patients, does not have the necessary support personnel, lacks appropriate rehabilitation facilities, and fails to keep abreast of the continuing education in head and neck surgical oncology, said Dr. Weber.

Fortunately, there are strategies that we can use to overcome many of the factors, such as rarity of the disease, lack of high-quality evidence-based data from randomized controlled trials, variations in practitioner experience, skill, bias, and philosophy, and differences in treatment center capabilities that affect the quality of head and neck cancer care, continued Dr. Weber. Some of these strategies are currently in use by head and neck surgeons and others are gaining in momentum.

Strategies to Improve Quality

Multiple strategies and opportunities exist for improving the quality of head and neck cancer care.

Head and neck surgeons should be familiar with and follow the National Comprehensive Cancer Network (NCCN) and/or specialty society evidence-based treatment guidelines during their decision-making process, to avoid omitting any aspects of appropriate care. These guidelines (www.nccn.org/professionals/physician_gls/PDF/head-and-neck.pdf ) are updated continually and are based on evaluation of scientific data integrated with expert judgment by multidisciplinary panels of physicians from NCCN member institutions. They clearly indicate the importance of having patients participate in and surgeons support clinical trials, as currently, fewer than 2% of head and neck cancer patients are entered into clinical trials.