Neoplasms

Respiratory Tract (Lung and Bronchial) Diseases

All Conditions

Skin and Connective Tissue Diseases

Digestive System Diseases

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Lung Neoplasms

Breast Neoplasms

Carcinoma, Hepatocellular

Urinary Bladder Neoplasms

Liver Neoplasms

Carcinoma

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Liver Diseases

Adenocarcinoma

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Each cluster starts receiving the intervention in sequence per cluster randomized control trial designs. Each cluster will participate in attending monthly coaching calls and compare their data on test results from pre-intervention to receiving the intervention.

When the cluster is not in active intervention, they are in the non-intervention period. The amount of time that each site contributes to the intervention depends on which cluster they belong to.

SAFER Change Package delivered using a Virtual Breakthrough Series \[VBTS\] Collaborative supplemented with automated surveillance data on test results.

SAFER TRACKS Intervention

Hardeep Singh, MD MPH

Improving communication is foundational to improving patient safety. Electronic health records (EHRs) can improve communication, but also introduce unique vulnerabilities. Failure to follow-up abnormal test results (missed results) is a key preventable factor in diagnosis and treatment delays in the VHA and often involves EHR-based communication breakdowns. Effective methods are needed to detect diagnostic delays and intervene appropriately. Manual techniques to detect care delays, such as spontaneous reporting and random chart reviews, have limited effectiveness, due in part to bias and lack of provider awareness of delays. They are also inefficient and cost-prohibitive when applied to large numbers of patients.

Diagnostic errors are considered harder to tackle, in part because they are difficult to measure. Rigorous measurement of diagnostic safety is essential and should be prioritized given the increasing amount of electronically available data. To create an effective measurement and learning program researchers must (1) ensure teams know how to take actionable steps on data and have assistance in doing so and (2) prioritize diagnostic safety at the organizational level by securing commitment from local VA leadership and clinical operations personnel. This will ensure that safety measurement will translate into action. The proposed study focuses on creating a novel program to develop and evaluate multifaceted socio-technical tools and strategies to help prevent, detect, mitigate, and ameliorate breakdowns in EHR-based communication that often lead to "missed" test results in the VHA.

The goal of this study is to develop and evaluate a new program for surveillance and improvement of test results-related diagnostic safety. The investigators will use a multifaceted measurement approach, the Virtual Breakthrough Series (VBTS) model, to account for processes of care and work systems issues as well as outcomes and implement change.

This is for Aim 2 of the study which was approved under IRB Protocol Number: H-45450. This study will implement the Change Package which was developed in the research team's recent work (Aim1, prior IRB Protocol Number: H-43661 from October 2018 - September 2019) via Virtual Breakthrough Series using a stepped-wedge cluster-randomized control trial. The study design involves random and sequential crossover of clusters from control to intervention until all clusters are exposed. A Change Package is a catalogue of evidence-based practices, change concepts, and action steps/strategies that help guide improvement efforts. VBTS involves monthly learning sessions where participants are provided with education/review of a specific component of a Change Package along with reviewing de-identified data, and having a facilitated discussion about successes, challenges, and implementation progress related to needed changes. The intervention will consist of coached implementation of the SAFER Change Package using a VBTS Collaborative, plus automated near real-time surveillance data on potentially missed test results through monthly data extraction within the Corporate Data Warehouse (CDW) platform.

The study's outcome measures will be the rate of missed test results, determined through random manual medical record review conducted nationally as part of the VHA performance-measurement system, known as the External Peer Review Program (EPRP) which has been collecting facility-level data on timeliness of communication of test results to patients within the time periods specified by VHA Directive 1088, as well as automated indicators (Triggers) of missed test results. Electronic surveillance will be made possible through the use of the research team's trigger algorithms which will determine the number of patients potentially lost to follow-up for the specified condition based on a previously validated timeframe. The triggers use the national EHR data warehouse (VINCI/CDW) to identify patients at risk for delays or patients who may have fallen through the cracks. For data surveillance, the investigators will apply five triggers to the medical record data contained within the CDW for the participating facilities during the Intervention Phase along with evaluating EPRP data. The research team hypothesizes there will be fewer missed test results in participating sites during the SAFER TRACKS Intervention as compared to during the pre-intervention period.

It's a cluster randomized control trial where 12 sites are randomized in groups of 4 in 3 clusters each.

VBTS participants, providers, and outcome assessors know about the intervention and in which conditions sites are in and when.

Measuring and Improving the Safety of Test Result Follow-Up

Number of missed test results determined by electronic indicators

Percentage of patients notified of actionable test results within seven days via EPRP

Michael E. DeBakey VA Medical Center

Baylor College of Medicine

Birmingham Veterans Affairs Health Care System

VA Office of Research and Development

Symptoms and General Pathology

Rare Diseases

Chronic Disease

Head and Neck Neoplasms

Chronic Graft Versus Host Disease

Head and neck cancer patients monitored on registry

Patients who are diagnosed with head and neck cancer and monitored by the Otolaryngology - Head and Neck Surgery clinic at Zuckerberg San Francisco General Hospital and Trauma Center will be included in this group. The intervention is the implementation of a registry, designed to replace existing paper-based systems for tracking patients. All head and neck cancer patients monitored by the clinic will be included.

Registry

Urmimala Sarkar, MD, MPH

To implement and evaluate a health information technology platform designed to support the management of patients with head and neck cancer in an urban, publicly-funded outpatient setting. This is an observational study; researchers will not assign specific interventions to study participants.

The investigators aim to implement and evaluate a health information technology (HIT) registry at an urban, public delivery system. The investigators will not assign specific interventions to the study participants, but rather observationally assess the effect of the HIT registry, designed to support routine medical care, on participants.

The investigators will use systems engineering methodologies to design, develop, and implement the platform. The platform will be implemented in the Otolaryngology - Head and Neck Surgery clinic that cares for patients with head and neck cancers. The study will assess patient outcomes and evaluate the time it takes for patients to progress through key treatment and post-treatment milestones before and after the HIT tool is implemented. The investigators will use models controlling for secular trend to estimate the effect of the tool on improving timely and successful completion of guideline-based care processes.

The HIT platform seeks to improve the monitoring and alerting functionality of existing systems. Specifically, it replaces paper-based systems previously used by the clinic to monitor its head and neck cancer patients. It will be implemented clinic-wide for all patients being treated for head and neck cancers. The investigators are not assigning a specific intervention to patients, but rather supporting the clinic and health system in the development of a population management platform that improves routine care processes. The platform is approved for clinical use and research by the San Francisco Health Network and the University of California, San Francisco.

The HIT platform users are clinicians who are responsible for monitoring patients with head and neck cancer and agree to partner with the investigators to improve monitoring processes. The clinicians involved may be asked to voluntarily participate in surveys, interviews, focus groups, and program evaluations. Patient medical records will be reviewed, but patients monitored on the registry will not be contacted by researchers.

Procedures are in place to monitor the registry. First, quality assurance is performed by the research team, information technology analysts, and software engineers. This includes checking that data in the platform matches source data, such as data entered in the electronic health record. In addition, the platform users are audited on a weekly basis. A data dictionary defining variables used in the platform exists and is updated as needed. Patients will be added to the registry by a clinician if they are diagnosed with head and neck cancer. The research team will support the clinicians in data analysis, although this will be performed with population-level, de-identified data. However, if unmediated adverse events are identified by the research team, the research team will alert the clinicians immediately. The HIT platform is designed to supplement, but not replace, the existing electronic health record. Data on the registry will be validated with source data and users will still engage with the source data and electronic health record as appropriate clinically and operationally.

Customized Registry Tool for Tracking Adherence to Clinical Guidelines for Head and Neck Cancers

Time from diagnosis to initiation of treatment

Proportion of patients that complete tumor board treatment recommendations

Time from diagnosis to presentation at tumor board

Time from diagnosis to first visit in oncology clinics

Proportion of patients who complete post-treatment radiation

Proportion of patients who are lost to follow-up

Agency for Healthcare Research and Quality (AHRQ)

University of California, San Francisco

Colorectal Neoplasms

Intestinal Neoplasms

Colonic Diseases

Intestinal Diseases

Rectal Diseases

simulation training

Karen L Larsen, m.d.

Some patients experience a degree of pain and discomfort during endoscopic examination of the large bowel. Sedatives and analgesics may be administered in low doses. Excessive dosage or intense pain may lead to hypotension and impaired level of consciousness. The purpose of the present study was to determine if simulation training of endoscopy staff in preventing pain and handling acute complications through effective teamwork could improve the quality of colonoscopy from the patients' perspective.

The study was carried out in a surgical department, where colonoscopies were performed on an out-patient basis under minimal sedation. The intervention consisted of a simulation based course for endoscopy staff. All endoscopy nurses and doctors participated (n=43). The course consisted of three short lectures followed by simulation training. The lectures dealt with technical aspects of colonoscopy, usage of medication and management of unexpected emergency events during the procedure, and finally with interprofessional teamwork and team communication. The lectures were followed by in situ simulation in an endoscopy room. For 2 months before and after the course a questionnaire based survey was carried out. The respondents were consecutive patients who had undergone colonoscopy under minimal sedation or no sedation (according to their own preference ). The questionnaire was filled out when the patient was fully recovered after sedation and ready to go home. The relevant nursing staff and doctor for the procedure also filled out their part of the questionnaire. Patients were invited to participate and gave written consent after oral and written information according to the Helsinki declaration .

Simulation Training of Endoscopy Staff to Improve Patient Experience in Colonoscopy

Simulation Based Team Training of Endoscopy Staff May Improve Patients' Perception of Colonoscopy

comparison of patient satisfaction aspects of colonoscopy before and after a simulation, course for staff. The patients fill out a questionnaire: Pain score on a visual analogue scale, Wiilingness to return for a repeat colonoscopy if necessary on a visual analogue scale, assessmment of doctor's and nurse's behaviour on a scale from 1 - 10 regarding empathy, quality of information. Staff answer a questionnaire where they assess the quality of teamwork on a scale from 1-10. They also assess the patients perceived pain on a visual analogue scale.

comparison of staff's perception of quality of teamwork before and after a simulation course

Aalborg University Hospital

Video-assisted thoracoscopic surgery team, from institution/hospital 1.

Video-assisted thoracoscopic surgery team, from institution/hospital 2.

Video-assisted thoracoscopic surgery team, from institution/hospital 3.

Video-assisted thoracoscopic surgery team, from institution/hospital 4.

Good non-technical skills (NTS) have been shown to prevent adverse events and errors. Improvements of NTS can be achieved by simulation based-team training.The NTS of the operating theatre team performing video-assisted thoracoscopic surgery (VATS) is speculated to differ fra open thoracic surgery, as is the case with technical skills; however, these have not been investigated. The aim of this study is to explore which NTS the members of the VATS team perceive to be most important to patient care and safety. Exploration will be done through a deductive, qualitative analysis of semi-structured group and individual interviews with VATS team members. A theoretical perspective of Hollnagels Safety-II will be taken using the taxonomy of Oxford Non-Technical Skills (NOTECHS) system with the aim of informing patient safety.

BACKGROUND:

Non-technical skills (NTS) can be defined as 'the cognitive, social and personal resource skills that complement technical skills, and contribute to safe and efficient task performance'. Human errors, such as communication breakdowns, lack of speaking up and of good leadership, are known to contribute considerably to adverse events. Adverse events are common in the operating theatre affecting patient safety. Adaptive behaviours have been shown important as a response to the dynamic, complex world of the operating theatre to prevent potential problems and adverse events.

As with technical skills, NTS can be taught by team training. Team training have been shown to improve attitudes as well as NTS, and reduced technical errors. Large studies have additionally shown that team training can reduce adverse events and improve patient outcome. A training intervention targeted at operating theatre teams will need to start with an assessment uncovering the learning needs of the team members.

In general minimally invasive surgery (MIS) is shown to be more complex, involve more personnel and take longer time than open surgery. The technical skills are different, among other things due to complex equipment and two-dimensional vision of a three-dimensional operating space. In our systematic review (submitted), only few studies investigated the NTS in MIS teams. The communication in MIS compared to open surgery were found to be different, relating more to equipment and patient related topics. Working in fixed teams improved teamwork climate in MIS teams.

Correspondingly, the NTS of the video-assisted thoracoscopic surgery (VATS) operating team is speculated to differ from the NTS needed in open surgery as is the case with the technical skills. However, no studies investigated the NTS of VATS teams.

The aim of this study is to explore, which NTS the members of the VATS team perceive to be most important to high quality patient care and patient safety.

METHODS:

Frameworks/theory:

The theoretical conceptual framework for the study is the safety theory by Erik Hollnagel, named Safety-I and Safety-II, arguing for a new view on safety: Safety-II. In Safety-I, the ontology is that things either function or malfunction, that could be a piece of equipment or healthcare professionals following procedures or guidelines. Consequently, the aetiology of the outcomes can be explained by a cause-effect relationship, where the malfunction of things linearly cause an unwanted effect. The resulting phenomenology then refers to outcomes as adverse events / incidents/ accidents. Oppositely, in Safety-II, the ontology is that in socio-technical systems, such as the healthcare system, performance adjustments is needed to adjust work, that is the task and the tools, to the actual situation of the complex world. Hence, as the technology only can vary to a limited extent, human performance needs to vary. The aetiological explanation in Safety-II is therefore, that performance variability resonate through both proactive and reactive adjustments into observed outcomes, named emergent outcomes. The resulting phenomenology sees the performance variability as both the basis of adverse events and of acceptable outcomes; that is everyday activities. These performance adjustments can be categorised into three types of adjustments: Maintaining/creating, compensating and avoiding, thereby characterising the performance variability for a specific activity. In all, the starting point is turned around. In Safety-II, the focus is on why and how things go right with the aim of understanding everyday activities, termed 'Work-as-Done', in contrast to the less interesting written procedure guidelines etc., termed 'Work-as-Imagined'.

Within non-technical skills research and education in healthcare, and especially within the specialities working in the operating theatre, a taxonomy widely used is the framework of behavioural markers adapted from the aviation industry, termed the Oxford Non-Technical Skills (NOTECHS) system. This framework is structured around four categories, divided into several elements each represented by examples of good or poor behavioural markers. This system has been developed and evaluated for operating teams and assesses both the team and each subteam's NTS. In this study, the taxonomy of the NOTECHS system in the perspective of the conceptual theory of Safety-II will be used as framework for the data analysis as described in detail below. In all, the behavioural markers representing good behaviours will therefore be the focus of this study to explore how things go right as this is much often the case than not. Interviewing the actual VATS team members themselves will explore their own perception of the NTS used in their everyday activities including the needed adaptions to situational requirements, found by others. This will represent 'Work-as-Done' rather than 'Work-as-Imagined' with the aim of informing the Safety-II perspective on patient safety.

Design:

The study will use the theories described above in an explorative semi-structured interview study. The data collection and thereby sample size will be an iterative process until no new data is revealed, hence saturation is met. This will include interviews of both multi-professional teams and individuals depending on the data revealed during the interviewing-analysing process. Interviews will be conducted by KG and ASM using a semi-structured interview guide. The interview guide will be adjusted during the iterative process of interviews and analysis. All interviews will be audio-recorded and transcribed verbatim. The study will be reported in accordance with the Standards for Reporting Qualitative Research (SRQR). Quality and rigour will be aimed for as suggested for qualitative research.

Ethics:

The Regional Scientific Ethics Committee of the Capital Region will be applied; however, we expect a letter of exemption due to Danish laws on educational studies not involving patients. Participants will receive oral and written information and will have to give informed consent with the continuous option of retracting their consent and participation. Personal data will be stored according to Danish Data Protection Law, and will be presented anonymously. The study protocol will be registered at www.clinicaltrials.gov.

Participants, setting and time:

Participants will be purposefully sampled as subject matter experts in terms of VATS operating teams in conjunction with individuals. The teams will consist of one or two surgeon(s) with VATS experience, one younger assisting surgeon, one anaesthesiologist, one nurse anaesthetist, and one to two scrub nurses with experience as both assisting and circulating nurse. The individuals will be relevant healthcare professionals of any of the above. Participants will come from the four university hospitals performing VATS in Denmark in collaboration with head of departments. Each person will only be included in one team interview and/or one individual interview. The interviews are planned to be conducted in February and March 2016.

The interview guide:

The interview guide will be semi-structured with a scripted introduction before each interview setting the scene and the topic of the interview. The interview will try to explore all four NOTECHS categories, namely leadership \& management, teamwork \& co-operation, problem-solving \& decision-making, and situation awareness in a Safety-II perspective, focusing on the performance variability of the team members needed in their daily work to adapt to situational requirements. Emphasis will be laid on allowing all team members to give their perspective in order to explore views of the entire team. The interviews will be semi-structured so probe questions will be used when necessary to obtain additional information.

Prior to conducting the interviews, two authors (KG, ASM) will spend a number of hours observing VATS procedures in order to become familiar with the procedures and with any critical phases of the operations. This, along with input from experienced VATS surgeons (RHP, HJH) and an experienced anaesthesiologist (DO), will inform the interview guide. The interview guide will be internally reviewed by the authors consisting of surgeons, a scrub nurse and an anaesthesiologist that are experienced qualitative and NTS researchers. It will be pilot tested on healthcare professionals without specific NTS knowledge to avoid misunderstanding and misinterpretation; however, these data will not be included in the study.

Data collection and analysis:

The interviews will be conducted face-to-face in undisturbed rooms in relation to the operating theatre in or just after normal working hours depending on working schedule. The participants demographic data will be collected consisting of profession, age, gender, years of clinical experience, years and type of experience with laparoscopic or VATS procedures and previous experience with NTS training.

A deductive data analysis strategy will be applied in this study. With the taxonomy of the NOTECHS framework we will use directed content analysis to analyse the interviews. Directed content analysis can be applied when 'prior research exists about a phenomenon that is incomplete/would benefit from further description'. As we approach the topic from a Safety-II perspective, focus will be on which behaviours the VATS team members perceive as important in insuring that things go right thereby insuring high quality patient care and patient safety. Explicitly we will focus on performance variability in their everyday work, categorising them as either maintaining/creating, compensating or avoiding.

The strategy is to use the categories of NOTECHS as well as categories of performance variability, when reading the transcribed interviews. The text will then be coded into these categories for condensation, adding new ones when extra text of interest is uncovered in order to avoid missing important new information that could inform the theory on NTS in VATS teams. The text coded will be marked to adhere to one of the categories, introducing new categories if needed. The texts will then be paraphrased to condense the interview quotations into observable behavioural examples.

The analyses will be conducted by KG and ASM. The first interviews will be coded by both KG and ASM; the coding will be discussed between these two and LS/DO. When agreement is satisfactorily, the two authors will split up and code the remaining interviews independently. The results of the coding will be discussed with LS/DO and later the full group of authors. The analysis will be conducted using NVivo (version 10).

Acknowledgements:

The authors will like to thanks the participating cardiothoracic departments in Denmark.

PROJECT ORGANISATION:

This study will be conducted at Copenhagen Academy for Medical Education and Simulation (CAMES), at Rigshospitalet, Capital Region of Denmark and Copenhagen University.

Members of the research group:

Project leader, MD, PhD student Kirsten Gjeraa (KG) Interviewer and analyser, CRN Anna Sofie Mundt (ASM) Co-supervisor, MD, PhD Lene Spanager (LS) Co-supervisor, MD Henrik Jessen Hansen (HJH) Co-supervisor, MD René Horsleben Petersen (RHP) Co-supervisor, MD, PhD, associate professor Lars Konge (LK) Supervisor, MD, DMSc, MHPE, professor Doris Østergaard (DO)

Publication:

The results will be published in an international journal.

Author list:

Kirsten Gjeraa, Anna Sofie Mundt, Lene Spanager, Lars Konge, René Horsleben Petersen, Henrik Jessen Hansen, Doris Østergaard.

Video-assisted Thoracoscopic Surgery Teams' Perception of Non-technical Skills

Important Non-technical Skills When Performing Video-assisted Thoracoscopic Surgery: Perceptions of the Operating Team

Group interviews, and individual interviews if nessesary, with the VATS team members.

Copenhagen Academy for Medical Education and Simulation

PhD student, medical doctor.

Prostatic Neoplasms

Genital Neoplasms, Male

Urogenital Neoplasms

Genital Diseases

Genital Diseases, Male

Urogenital Diseases

Prostatic Diseases

Male Urogenital Diseases

Patients who elect to be monitored by an Active Surveillance protocol for prostate cancer

Patients who are diagnosed with prostate cancer and elect to be monitored by an Active Surveillance protocol by the Urology Clinic at Zuckerberg San Francisco General Hospital and Trauma Center will be included in this group. The intervention is the implementation of a registry, designed to replace existing but suboptimal systems for tracking patients. All Active Surveillance patients monitored by the clinic will be included.

To implement and evaluate a health information technology platform designed to support the management of patients on active surveillance for prostate cancer in an urban, publicly-funded outpatient setting.

We aim to implement and evaluate a health information technology (HIT) registry at an urban, public delivery system. We will use systems engineering methodologies to design, develop, and implement the platform. The platform will be implemented in the Urology clinic that cares for patients with prostate cancer. We are conducting a prospective non-randomized pilot study that will follow men who choose active surveillance as a management strategy for prostate cancer. We aim to assess the impact of the HIT registry on patient monitoring and adherence.

The HIT platform seeks to improve the monitoring and alerting functionality of existing systems. Specifically, it replaces paper-based or ineffective computer-based systems previously used by the clinic to monitor its active surveillance patients. It will be implemented clinic-wide for all patients being monitored by an active surveillance protocol. The platform is approved for clinical use and research by the San Francisco Health Network and the University of California, San Francisco.

Research involves materials that are collected for nonresearch purposes, as well as low-risk research employing survey, interview, focus group, program evaluation, and human factors methodologies. We will solicit structured feedback from registry users designed to continuously evaluate and improve performance in a clinical area to reduce patient safety gaps. Patient medical records will be reviewed, but patients monitored on the registry will not be contacted by researchers.

Procedures are in place to monitor the registry. First, quality assurance is performed by the research team, information technology analysts in the San Francisco Health Network, as well as by the third-party software provider. This includes checking that data in the platform matches source data, such as data entered in the electronic health record. In addition, users are audited on a weekly basis. A data dictionary defining variables used in the platform exists and is updated as needed. The HIT platform users include clinicians who are responsible for monitoring patients on active surveillance for prostate cancer. Patients who are enrolled in the active surveillance program will be added to the registry by a clinician. The research team will support the clinicians in data analysis, although this will be performed with population-level, de-identified data. However, if unmediated adverse events are identified by the research team, the research team will alert the clinicians appropriately. The research team will also develop training materials and conduct training sessions to ensure that all clinicians responsible for monitoring patients on active surveillance are provided with up-to-date resources and accessible support. The HIT platform is designed to supplement, but not replace, the existing electronic health record. Data on the registry will be validated with source data and users will still engage with the source data and electronic health record as appropriate clinically and operationally.

An Electronic Registry to Improve Adherence to Active Surveillance Monitoring at a Safety-net Hospital

An Electronic Registry to Improve Adherence to Active Surveillance Monitoring Among Men With Prostate Cancer at a Safety-net Hospital: A Study Protocol

measured from date monitoring (e.g. prostate-specific antigen test or biopsy) is scheduled to date monitoring occurs.

Acceptability and feasibility of the intervention among clinicians will be measured using the Technology Acceptance Model (Venkatesh et al). Semi-structured interviews will be conducted to assess usefulness and ease of use.

The proportion of patients who are lost to follow-up, defined as three subsequent unsuccessful outreach attempts

Adherence to monitoring (e.g. prostate-specific antigen test every 3 months) will be assessed. Monitoring will be considered adherent if it occurs within 30 days of the recommendation.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Measuring and Improving the Safety of Test Result Follow-Up	NCT04166240	Lung Cancer Breast Cancer Colon Cancer Bladder Cancer Hepatocellular ...	SAFER TRACKS In...	18 Years - 65 Years	VA Office of Research and Development
Customized Registry Tool for Tracking Adherence to Clinical Guidelines for Head and Neck Cancers	NCT03546322	Head and Neck N...	Registry	18 Years -	University of California, San Francisco
Simulation Training of Endoscopy Staff to Improve Patient Experience in Colonoscopy	NCT02428907	Colorectal Canc...	simulation trai...	18 Years -	Aalborg University Hospital
Measuring and Improving the Safety of Test Result Follow-Up	NCT04166240	Lung Cancer Breast Cancer Colon Cancer Bladder Cancer Hepatocellular ...	SAFER TRACKS In...	18 Years - 65 Years	VA Office of Research and Development
Customized Registry Tool for Tracking Adherence to Clinical Guidelines for Head and Neck Cancers	NCT03546322	Head and Neck N...	Registry	18 Years -	University of California, San Francisco
Customized Registry Tool for Tracking Adherence to Clinical Guidelines for Head and Neck Cancers	NCT03546322	Head and Neck N...	Registry	18 Years -	University of California, San Francisco
Video-assisted Thoracoscopic Surgery Teams' Perception of Non-technical Skills	NCT02679872	Lung Cancer		-	Copenhagen Academy for Medical Education and Simulation
Measuring and Improving the Safety of Test Result Follow-Up	NCT04166240	Lung Cancer Breast Cancer Colon Cancer Bladder Cancer Hepatocellular ...	SAFER TRACKS In...	18 Years - 65 Years	VA Office of Research and Development
An Electronic Registry to Improve Adherence to Active Surveillance Monitoring at a Safety-net Hospital	NCT03553732	Prostatic Neopl...	Registry	18 Years -	University of California, San Francisco

Spots Global Cancer Trial Database for patient safety