Multidisciplinary Management & Pulmonary Nodule Clinic

1. Multidisciplinary Management & Pulmonary Nodule Clinic The St. John experience Presented By: Zyad Kafri, M.D.

2. St. John Hospital and Medical Center is more than 400-bed teaching hospital in Detroit Part of the St. John Providence health system and Ascension health We offer excellence in cancer treatment at multiple system wide cancer centers We are committed to improve the quality and timeliness of cancer care Develop system wide strategies to emphasize early detection and improve early stage lung cancer care St John Hospital and medical canter

3. Many cases presenting to the hospital (ER) are found accidently to have abnormal chest imaging Many patients in our community are considered at high risk of developing lung cancer without access to routine screening test Patient presenting with symptomatic lung cancer usually have advanced non-curable disease Accidently discovered lung nodules are often managed by different specialists and their care is fragmented and often delayed (missed opportunity) Lung nodules that discovered in high risk population are good investment for early detection and often cure of suspected early stage lung cancer Need standardization of evaluation and follow up process (quality) and make the process more predictable (timeliness) Problem Statement

4. No routine follow up done on abnormal chest imaging at the ER Patients with lung nodules are managed individually on case by case basis No standardization of care or referrals Evaluation is usually delayed and fragmented Referring staff awareness Patient satisfaction Constraints

5. Develop a mechanism to capture all missed opportunities Improve the quality of care by developing and organizing a predictable lung nodule evaluation and management process The process has to be self sustained and system based Consistent with the standard practice guidelines Increase staff awareness of the process Patient centered to improve patients’ satisfaction Aim Statements

6. W have met with the multidisciplinary thoracic team and decided to proceed with the stated aims. We formed a core committee that meets often on weekly basis. Flow chart, value stream map and process map, were all developed. Action Plan

7. Data/Results/Charts

8. Improvement Measures

9. Change-Improve the system • Designate a multidisciplinary core team with pulmonology champion • Hiring Thoracic Oncology Program coordinator and establish a lung nodule database • Standardizing lung CT-scan reporting • Develop new lung nodule pathway with pulmonology, diagnostic radiology and thoracic surgery • Flagg accidentally discovered cases then forwarded the list to the thoracic oncology program coordinator for further action • Lung nodule case conference • Establish a process of communication and data exchange with primary care referring network • Establish and consolidate the Low dose screening chest CT scan and reporting mechanism

15. Sustain • Hire a full time thoracic program navigator • Maintain lung nodule case database • Maintain weekly lung nodule board meetings (case conference) • Monthly review of the data tool/registry • Quarterly reports to cancer committee and the administration • Develop partnership with other health network sites • Develop partnership with referring network

16. Thank You