Multidisciplinary, collaborative, specialized care is superior, especially concerning complex surgical care. In 2004, we formed a unified thoracic surgery program (TSP) within a large non-university health system involving competing private practice surgical groups in 2 tertiary care hospitals in a major metropolitan area. We examine the results of this unusual collaboration.
All surgeons performing thoracic surgery within general or cardiothoracic groups and participating in multi-disciplinary care were invited to join the TSP. Multidisciplinary care was defined by involvement in weekly Multi-disciplinary Thoracic Oncology conferences (MTOC). Initially, members met periodically to standardize care patterns as reflected in perioperative orders & protocols. All orders & protocols were published on the TSP internet site, assuring ready access for clinical use. They are annually updated. A dedicated TSP data manager prospectively gathered all thoracic cases, entering them into a clinical database. A monthly professional journal club reviews the most current evidence-based cardiothoracic literature. Quarterly morbidity & mortality meetings analyze running 12 months of data segregated into meaningful clinical categories (lobectomy, pneumonectomy, pleural, etc). Program trends are discussed relative to the literature & TSP results. Alterations of care patterns are reflected in updated orders and protocols. Quality improvement projects are accomplished (e.g. patterns & outcomes of chest tube duration).
Each item is chronologically arranged 2005–2008. # cases MTOC: 775, 681, 829, 836. TSP Surgeons/Others: 9/11, 8/15, 8/20, 7/12. Case vol TSP surg/Others: 419/33, 448/50, 512/76, 506/75. % 2 highest vol TSP surg: 48%, 52%, 64%, 75%. No Complications: 79.4%, 86.7%, 80.4%, 81.2%. Lobectomy (# cases): 96, 96, 117, 135. Lobectomy Mortality @ D/C: 4.2%, 0%, 2.6%, 0.7%.
TSP surgeons performed the vast majority of cases with 2 high volume surgeons contributing an increasing proportion. Case volume has increased for the TSP; including all surgeons. Volume of signature cases increased annually with outstanding quality indicators (e.g. thoracic lymphadenectomy-LND) and outcomes. Complex, technically advanced cases were frequent.
TSP collaboration in large non-university health system in a major metropolitan area is successful.
John Handy, No Financial Disclosure Information; No Product/Research Disclosure Information