title: Improvements in thoracic surgery outcomes: a multi-institutional collaboration study.
abstract: BACKGROUND
  Treatment protocols (including those for thoracic surgery) tend to be customized for individual hospitals. Procedural standardization is required to improve surgical tasks and patient outcomes. This study aimed to evaluate the effects of an initiative to standardize surgical tasks for efficient and safe performance.
  
  
  METHODS
  Hospitals associated with the Division of Chest Surgery of the Kyoto Prefectural University of Medicine held joint meetings involving their thoracic surgeons and operating room nurses between February 2011 and November 2012 to standardize surgical tasks. Operation times and blood loss were compared before and after standardization.
  
  
  RESULTS
  The implementation rate of standardized surgical tasks was 97%. The pre-operative (from entry to the operating room until commencement of surgery) and post-operative (from conclusion of surgery until departure from the operating room) times were significantly decreased after the standardization. When compared according to operative group (all thoracic surgery, lung lobectomy, and partial lung resection), operation times were shorter for all three groups; in addition, the amount of blood loss was lower in all three groups after standardization. A post-standardization survey showed improved morale among the meeting participants.
  
  
  CONCLUSIONS
  Interdisciplinary standardization of surgical tasks across institutions improved thoracic surgery tasks and surgical outcomes.
authors.affiliation: Department of Thoracic Surgery, Nantan General Hospital, Kyoto, Japan. Y-Iwasaki@sings.jp.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwasaki
authors.affiliation: Division of Chest Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. shimajun@beige.plala.or.jp.
authors.forename: Junichi
authors.initials: J
authors.lastname: Shimada
authors.affiliation: Division of Chest Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. dkatoh@gray.plala.or.jp.
authors.forename: Daishiro
authors.initials: D
authors.lastname: Kato
authors.affiliation: Department of Thoracic Surgery, Saiseikai Suita Hospital, Osaka, Japan. fs2m-nsmr@asahi-net.or.jp.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Nishimura
authors.affiliation: Department of Thoracic Surgery, Yamashiro General Medical Center, Kyoto, Japan. kazuitoh@me.com.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Chest Surgery, Nara City Hospital, Nara, Japan. terauchi@iris.eonet.ne.jp.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Terauchi
authors.affiliation: Department of Thoracic Surgery, Ayabe City Hospital, Kyoto, Japan. shimomu@hera.eonet.ne.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Shimomura
authors.affiliation: Division of Chest Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. tsune824@nifty.com.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tsunezuka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D003299:Cooperative Behavior; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009871:Operating Room Nursing / Q000592:standards; D009873:Operating Rooms / Q000592:standards; D061646:Operative Time; D011013:Pneumonectomy / Q000592:standards; D011184:Postoperative Period; D058996:Quality Improvement; D017751:Safety Management / Q000458:organization & administration; D019616:Thoracic Surgical Procedures / Q000592:standards*; D055815:Young Adult