Download DEVELOPMENT AND IMPLEMENTATION OF A LUNG NODULE

DEVELOPMENT AND IMPLEMENTATION OF A LUNG NODULE PROGRAM
Tamra Kelly, BS RRT-NPS, Gary B. Mertens, RCP, CPFT, Jenifer Beasley, RRT,
Departments of Cancer Services and Cardiopulmonary Services, Sutter Roseville
Medical
Center
(SRMC)
Background
The National Comprehensive Cancer Network (NCCN) and the American Lung
Association (ALA) published new Lung Nodule/Cancer Screening and Treatment
guidelines in November 2012. We developed an implementation plan for a Lung
Nodule Center to support the healthcare needs of our community. During 2012/2013
we successfully implemented phase one of this program, a Regional Lung Nodule
Center accepting referrals from physicians across our community who notice
incidental lung nodules or nodules identified during routine screening.
Lung cancer is the leading cause of cancer death among men and women. A
contributing factor is that lung cancer usually presents with no visible symptoms
until it has progressed to a higher stage; 85% of patients will be diagnosed at Stage 3
or 4. Only about 30% of patients in the U.S. are detected in the early stages of the
disease, contributing to its low overall survival rate.
Methods
The SRMC Cardiopulmonary Services Department worked with a multidisciplinary
team including Respiratory Care Practitioners, Nurse Navigators, Pulmonologists,
Thoracic Surgeons, Radiologists and Oncologists to develop and implement a Lung
Nodule Center. The center was designed around the ‘NCCN Lung Cancer
Screening/Treatment Guidelines’ from November 2012. Our center reviews patient
referrals with a multidisciplinary team to develop a plan of care per national
guidelines, minimize unnecessary procedures or radiation exposure, alleviate patient
anxiety, shorten the time from detection to treatment and provide patients access to
comprehensive support services through our Sutter Cancer Centers. The goals of
our center are to provide our patients appropriate testing, follow up and intervention
for suspicious lung masses. We use the latest technology, including CT, MRI, and
PET scanning, Endobronchial Ultrasound (EBUS), Electromagnetic Navigational
Bronchoscopy (ENB) and video-assisted thoracic surgery. The Respiratory Therapy
department provides consultation and the bronchoscopy services used in this
program.
Results
Opened in late 2012, we have reviewed 188 patients in our Center. We have
confirmed cancer for 52 patients, ruled out cancer for 53 patients and continue to
follow 83 patients per NCCN guidelines. This has generated a high volume of
imaging, lab and diagnostic bronchoscopy procedures which have added volume
and revenue to the RT department and quality for our patients.
PDSA Model For Improvement
Plan
Implement collaborative interprofessional Lung Nodule program
to diagnose and treat Lung Nodules at an earlier stage.
Data
Do
•Engaged staff and physician
champions
•Volunteers were trained on
interprofessional team building
•Developed evidence based
procedures and scripts
•Implemented interprofessional LN
conference and clinic
Act
The process is
evolving as we
monitor our data and
receive input from
stakeholders.
Screening CT
program
implemented Sept
2014.
Study
Tracking nodules based on size, repeat imaging based on NCCN
guidelines, obtaining tissue for diagnosis as indicated, tracking
stage at diagnosis etc.
Tools
Conclusion
Implementation of a Lung Nodule Center by Respiratory Care Practitioners as part of
a multidisciplinary team has successfully met the goal of detecting and treating lung
nodules and cancer at an earlier stage. This program has improved relationships
between RCP’s, Cancer Nurse Navigators and physicians who see value in
assessment by qualified RCP staff. Having RCP’s expand their role into new areas of
care such as a lung cancer center increase the value RCP’s bring to patient care.
The presenter has no conflicts of interest. There was no research funding, sponsorship, or research support for this work.