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Abstract: Poster Presentations |

RESULTS OF IMPLEMENTATION OF A THORACIC SURGERY PROGRAM IN A LARGE NON-UNIVERSITY METROPOLITAN HEALTH SYSTEM FREE TO VIEW

John R. Handy, MD*; Kelly Denniston, RHIT; Anthony Furnary, MD; Gary Y. Ott, MD; E Charles Douville, MD; Ron Wolf, MD; Eric Kirker, MD; Cathy Betzer, BS
Author and Funding Information

Providence Cancer Center, Portland, OR


Chest


Chest. 2009;136(4_MeetingAbstracts):135S-b-136S. doi:10.1378/chest.136.4_MeetingAbstracts.135S-b
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Abstract

PURPOSE:  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.

METHODS:  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).

RESULTS:  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%.

CONCLUSION:  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.

CLINICAL IMPLICATIONS:  TSP collaboration in large non-university health system in a major metropolitan area is successful.

DISCLOSURE:  John Handy, No Financial Disclosure Information; No Product/Research Disclosure Information

Wednesday, November 4, 2009

12:45 PM - 2:00 PM


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