The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

USING A MULTIDISCIPLINARY TEAM IMPROVES THE OUTCOME OF LUNG VOLUME REDUCTION SURGERY

Mary K. Hart, Erika Abmas, Lucy Aguirre-Kelly, Ana Lotshaw, Mark Millard; Baylor University Medical Center, Dallas, TX

Introduction: Lung Volume Reduction Surgery (LVRS) in patients with severe emphysema may improve COPD outcomes, but carries a defined perioperative risk. By reducing lung hyperinflation, the surgery has shown improvements in spirometry, respiratory muscle function, gas exchange, breathlessness, and exercise capacity all leading to improved quality of life. Patient selection criteria are strict and pre and post operative care significantly impacts the outcomes. Method: All patient charts from LVRSS performed during 2005 - 2006 were reviewed by the LVRS Committee for outcomes data with the finding of unacceptable lengths of stay (LOS), morbidity and mortality. In response, a multidisciplinary team of specialists that included MD, RRT, OT, PT, RN, SW began work on how to improve the process. Using a fishbone cause and effect diagram and affinity chart, areas of improvement were identified and prioritized. A flow chart was used to track the current process which showed lack of communication and staff training to be the greatest causes for these findings. As a result, a plan was developed for the team to standardize appropriate care plans, and was broadly disseminated to all ICU and general care clinicians by the LVRS team members. The new process was adopted and quickly put into action. Special attention was given to providing the post-operative LVRS patient with a quiet and supportive environment and assuring adequate pain control. Same day surgery mobilization by PT with exercise was instituted. Results: 4 patients prior to and 5 patients post implementing the new process and coordinated team approach were compared for length of stay (LOS), post surgical complications and mortality. Prior to intervention, LOS was 51 days compared to the national average of 7-14 days which was related to post-operative complications, as well as, excess mortality. Implementing a new paradigm of care decreased the average LOS to 11 days with minimal morbidity and zero mortality. Conclusion: We used established quality improvement tools to quickly identify deficiencies, put a plan in place and tracked outcomes. The changes made in the delivery of care significantly improved patient outcomes. Our success is based on having a dedicated well trained multidisciplinary LVRS team. Sponsored Research - None

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