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Implementation of an Anterior Mediastinal Mass Pathway to Improve Time to Biopsy and Multidisciplinary Communication
Rachel E Gahagen1,2, William C Gaylord1,3, Meghan D Drayton Jackson1,3
1From the Division of Pediatric Critical Care Riley Hospital for Children.
Insights
A new protocol significantly reduced biopsy time for pediatric anterior mediastinal masses by 38%. This quality improvement initiative also enhanced multidisciplinary team communication, improving patient care pathways.
Area of Science:
- Pediatric Oncology
- Quality Improvement Science
- Thoracic Surgery
Background:
- Mediastinal masses in children with cancer pose significant risks, including respiratory and hemodynamic compromise.
- Managing these complex cases is hindered by challenges in multidisciplinary communication.
- Delayed diagnosis and treatment were observed in pediatric patients with mediastinal masses.
Purpose of the Study:
- To reduce the time to biopsy for anterior mediastinal masses in pediatric cancer patients by 25%.
- To improve multidisciplinary communication among care teams within six months of protocol implementation.
Main Methods:
- Implemented a quality improvement pathway involving early multidisciplinary communication via a HIPAA-compliant texting platform.
- Established clear communication channels between emergency departments and surgical/medical teams.
- Determined biopsy approach and timing based on patient stability, imaging, and sedation risks.
Main Results:
- The pathway was utilized 20 times, achieving a 38% reduction in time to biopsy (from 25.1 to 15.4 hours).
- No statistically significant reduction in time to pathology results was observed.
- Multidisciplinary team communication scores improved from a baseline of 3.24 to 4 on the Likert scale.
Conclusions:
- Early initiation of multidisciplinary communication effectively reduced biopsy times for pediatric anterior mediastinal masses.
- The implemented pathway improved care delivery for children with these critical conditions.
- Enhanced communication strategies are vital for optimizing the management of pediatric mediastinal masses.
Background:
Mediastinal masses in children with cancer present unique challenges, including the risk of respiratory and hemodynamic compromise due to the complex anatomy of the mediastinum. Multidisciplinary communication is often a challenge in the management of these patients. After a series of patients with mediastinal masses were admitted to Riley Hospital for Children Pediatric Intensive Care Unit, the time from presentation to biopsy and pathology was greater than expected. We aimed to reduce the time to biopsy by 25% and demonstrate improved multidisciplinary communication within 6 months of protocol implementation for patients presenting to Riley Hospital for Children Emergency Department with an anterior mediastinal mass.
Methods:
Quality improvement methodology created a pathway that included early multidisciplinary communication. The pathway includes communication between the emergency department and multiple surgical and medical teams via a HIPPA-compliant texting platform. Based on patient stability, imaging findings, and sedation risks, the approach and timing of the biopsy were determined.
Results:
The pathway has been used 20 times to date. We successfully reduced the time to biopsy by 38%, from 25.1 hours to 15.4 hours. There was no statistically significant reduction in time to pathology. The multidisciplinary team reported improved communication from a baseline Likert score of 3.24 to 4.
Conclusions:
By initiating early multidisciplinary communication, we reduced the time to biopsy and pathology results, improving care for our patients presenting with anterior mediastinal masses.
