Achieving a 3-Star Society of Thoracic Surgery Lobectomy Ranking by Using Continuing Process Improvement, Lean...

Area of Science:

• Thoracic Surgery
• Quality Improvement
• Healthcare Analytics

Background:

• The Society of Thoracic Surgeons (STS) utilizes specific metrics to rank lobectomy programs.
• Improving patient outcomes and achieving higher rankings requires a systematic approach to quality enhancement.

Purpose of the Study:

• To identify the Society of Thoracic Surgeons (STS) metrics used for ranking lobectomy procedures.
• To detail a process for improving lobectomy outcomes using root cause analysis and lean methodology.

Main Methods:

• Review of STS data for lobectomy programs.
• Application of root cause analysis to identify areas for improvement.
• Implementation of lean methodology and process changes, including enhanced pre-operative exercise, respiratory therapist integration, infection reduction strategies, and increased minimally invasive surgery adoption.

Main Results:

• Sixteen of 231 (7%) programs achieved a 3-star ranking over a 3-year period (July 2011-June 2014).
• Major morbidity decreased from 9.5% to 5.3% (P=0.001) and mortality decreased from 3.3% to 0.54% (P<0.0001) between August 2003 and December 2014.
• Failure to escalate care was a common root cause identified.

Conclusions:

• STS ranking metrics for lobectomy primarily focus on 30-day mortality and respiratory complications.
• Root cause analysis, lean methodology, and targeted process improvements can significantly enhance lobectomy patient outcomes.
• The implemented strategies facilitated achieving and maintaining a 3-star STS ranking, suggesting potential replicability for other institutions.