title: Systematic evaluation of quality of care provided to patients undergoing pulmonary surgery helps to identify areas for improvement.
abstract: Systematic assessment of care pathways may identify areas of potential improvement beyond that generated by traditional outcome measures alone. This approach was used to audit a single-surgeon's practice of pulmonary resection [182 patients over 21 months, median age of 69 (range 18-86) years] by choosing 10 gold standards in three areas of care. Preoperative: 1) Percentage cancer patients undergoing PET scan prior to surgery, 2) Percentage of patients with predicted postoperative FEV(1) (ppoFEV(1)) <40% who had gas transfer (DLCO) measured. Perioperative: 3) Percentage of operations postponed, 4-5) Percentage of cancer patients undergoing anatomical resections and systematic lymph node excision, 6) Rate of exploratory thoracotomies. Postoperative: 7-8) Risk-adjusted mortality according to thoracoscore and ESOS.01, 9) Percentage patients admitted to intensive care unit (ICU), and 10) Percentage patients discharged directly home from our unit. Postoperative mortality (2.2%), ICU admission (4%), exploratory thoracotomy (2.7%), and home discharge (98%) fared within standards. Only 57% of patients with a ppoFEV(1)<40% had DLCO tested, and eight cases (4.4%) were postponed on the day of surgery. Analysis of the processes of care identified areas for improvement (preoperative preparation of patients, theatre cancellations and intraoperative lymph node management) even in a practice with satisfactory risk-adjusted results.
authors.affiliation: Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK. lungsout@yahoo.com
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Martin-Ucar
authors.forename: Ayo
authors.initials: A
authors.lastname: Medouye
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Deacon
authors.forename: Nazli
authors.initials: N
authors.lastname: Muhibullah
authors.forename: Kelvin
authors.initials: K
authors.lastname: Lau
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bennett
authors.forename: Rajni
authors.initials: R
authors.lastname: Annamaneni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007430:Intraoperative Care / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality; D011300:Preoperative Care / Q000706:statistics & numerical data; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult