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  P3.07 - Poster Session 3 - Surgery (ID 193)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12542

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    P3.07-047 - Developing thoracic surgery quality across a broad region of western United States: Thoracic Surgery Initiative (TSI) (ID 3336)

    09:30 - 09:30  |  Author(s): J.R. Handy
    • Abstract

    Background
    Objective: In the United States, thoracic surgery quality, as measured in mortality, morbidity or processes (eg lymphadenectomy after lung cancer resection), is very heterogeneous between institutions and surgeons. Despite barriers involving surgeon specialties, payors and administrative systems, health care quality is measurable & implementable. We describe the Thoracic Surgery Initiative (TSI), a grass roots quality improvement effort within Providence Health & Services (PHS), which consists of 34 facilities providing healthcare over a large Western region (Alaska, California, Montana, Oregon & Washington).

    Methods
    Methods: The TSI was conceived and driven by a thoracic surgeon. A core team (surgeons, administrators, data manager) was formed, thoracic surgery (TS) service line specifics defined & identified (of 34 facilities, 14 perform TS), stakeholders identified & surveyed regarding interest & resources. A series of meetings, agreements and collaborations were formed to define and implement quality care with the following goals: decrease mortality & morbidity, clinical standardization & cost savings.

    Results
    Results: 2011- Feb 2012: (1) intra-mural grant for TSI development obtained, (2) development activities described above, (3) organizing meeting of stakeholders (40 attendees-12 hospitals) accomplished: (a) persuasion of site-specific & system leaders/physicians/administrators, (b) executive committee (EC), (c) operational calendar (bimonthly phone conferences). Surgeon-leader spent 265 hrs on project Aug 2011-Mar 2012. 2012 EC accomplishments: (1) formulated charter & mission statement, (2) agreed upon & defined TS clinical data elements, (3) determined system/site-specific data system costs, (4) endorsed electronic health record (EHR) as platform for standardization, (5) endorsed development of TS best practice. Dec 2012 meeting (42 attendees; 12 hospitals): (1) established data system requirements, (2) began system wide TS practice standardization using EHR (TS consult, op note, daily rounding note, discharge summary, clinic note, multidisciplinary thoracic oncology conference note), (3) consensus regarding required components of lung cancer screening program. 2013: Executive committee established best practice component candidates (performance status, clinical staging, lymphadenectomy, etc). Surgeons surveyed for importance of possible components. 38 components chosen for incorporation into EHR templates. Data system and EHR templates developed. Quarterly newsletter informs all TSI stakeholders.

    Conclusion
    Conclusion: Health care quality can be defined & implemented across a broad geographic area but requires dedicated physician leadership & support. The TSI serves as a model for other regions and systems to define & implement high quality thoracic surgery. Clinical data is required to monitor success.