title: A clinical audit in a multidisciplinary care path for thoracic surgery: an instrument for continuous quality improvement.
abstract: BACKGROUND
  Although it is advocated that (major) surgical procedures should be embedded in clinical pathways, the efficacy of such pathways is hardly ever systematically evaluated. The objective of our study was to assess the results of a multidisciplinary care path for patients undergoing thoracic cancer surgery, using a concurrent integrated prospective database.
  
  
  METHODS
  From April 2006 to December 2008, 169 eligible patients, admitted for thoracic cancer surgery in our institute, gave informed consent to participate in this prospective study. Detailed clinical data concerning patient-, tumour-, treatment- and outcome characteristics were collected. For evaluation of pain and quality of life (QoL), visual analogue scale (VAS) and SF-36 were used respectively. Information retrieved on 94 patients operated in the baseline period (until November 2007) was used in multidisciplinary consensus meetings to develop a new care path. After the introduction of this care path (January 2008) data-collection continued to evaluate outcome using the data of 75 patients operated in the evaluation period (until December 2008).
  
  
  RESULTS
  Data from the baseline period showed age (p=0.001), indication (p=0.03), postoperative pain (p<0.001) and complications (p<0.001) to be independently related to length of stay (LOS). Subsequently, the package of measures taken in the multidisciplinary care path were evaluated, showing significantly less postoperative pain (p=0.026) and a reduced length of hospital stay (p=0.014). In addition, a (trend towards) improvement in physical quality of life was observed 1 month (p=0.03) and 6 months (p=0.07) postoperatively.
  
  
  CONCLUSIONS
  The use of a prospective database integrated in a clinical care path for thoracic cancer patients revealed important improvements of the care process determining short- and long-term outcome. There was a significant reduction in length of hospital stay, postoperative pain and loss of quality of life. Ongoing and multicentre collection of such data can provide surgeons with instruments to further improve quality of care.
authors.affiliation: Department of Thoracic Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. r.numan@nki.nl
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Numan
authors.forename: Houke M
authors.initials: HM
authors.lastname: Klomp
authors.forename: Wilson
authors.initials: W
authors.lastname: Li
authors.forename: Dick R
authors.initials: DR
authors.lastname: Buitelaar
authors.forename: Jacobus A
authors.initials: JA
authors.lastname: Burgers
authors.forename: Johanna W
authors.initials: JW
authors.lastname: Van Sandick
authors.forename: Michel W
authors.initials: MW
authors.lastname: Wouters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D059408:Pain Management; D010149:Postoperative Pain; D011446:Prospective Studies; D058996:Quality Improvement; D011788:Quality of Life; D013903:Thoracic Surgery / Q000592:standards*; D055815:Young Adult