Article

Patient-Centered Quality Indicators for Pulmonary Resection

Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
The Annals of thoracic surgery (Impact Factor: 3.85). 10/2008; 86(3):927-32. DOI: 10.1016/j.athoracsur.2008.04.021
Source: PubMed

ABSTRACT

Quality of care is increasingly scrutinized. However, no standard quality measures exist for surgical care of patients undergoing pulmonary resection.
Our thoracic surgical team developed a set of patient-centered quality of care measures specific to patients undergoing pulmonary resection. Measures were chosen that demonstrated evidence-based preoperative assessment, adequate mediastinal staging, and interventions to prevent and expeditiously treat postoperative morbidity. Medical records of all patients undergoing pulmonary resection in 2005 were analyzed.
In all, 606 patients (men:women = 330:276) underwent 628 pulmonary resections. Median age was 65.8 years (range, 2 to 93). Operative mortality was 2.1%. Pulmonary function testing within 1 year before surgery was documented in 74.2%. Electrocardiogram within 90 days before surgery was documented in 81.6% of patients 50 years and older. Smoking history was documented in all patients, and smoking cessation consultation was offered to 85.7% of current smokers. Deep venous thrombosis prophylaxis was implemented in 99.7%. Mediastinal staging was documented in 94.0% of patients undergoing lung cancer resection (n = 333). Postoperatively, 92.4% of patients used incentive spirometry. Atrial fibrillation treatment occurred within 45 minutes of onset in 70.5%. Postoperative analog pain scores were above 6 in only 7.4% of assessments; treatment and reassessment occurred within 2 hours in 81.0%. Follow-up planning was documented at hospital discharge in 100%. No National Quality Forum "never events" occurred.
Patient-centered and clinically relevant quality measures can be developed and evaluated in general thoracic surgery. This panel of quality indicators highlights and guide areas for potential improvement in the care of patients undergoing pulmonary resection.

Full-text preview

Available from: ats.ctsnetjournals.org
  • Source
    • "Those patients with higher levels of pain (>4), with anxiety and longer hospital stays (>3 days), were assigned the highest priority for massage therapy and placed on the massage therapist appointment list.(33) Of those patients on the appointment list, some were excluded because they were unavailable at the scheduled massage times or refused massage at that time. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Thoracic surgery patients undergo long procedures and commonly have postoperative back, neck, and shoulder pain. Given the promising effects of massage therapy for alleviation of pain, we studied the effectiveness and feasibility of massage therapy delivered in the postoperative thoracic surgery setting. Patients who received massage in the postoperative setting had pain scores evaluated pre and post massage on a rating scale of 0 to 10 (0 = no pain, 10 = worst possible pain). In total, 160 patients completed the pilot study and received massage therapy that was individualized. Patients receiving massage therapy had significantly decreased pain scores after massage (p ≤ .001), and patients' comments were very favorable. Patients and staff were highly satisfied with having massage therapy available, and no major barriers to implementing massage therapy were identified. Massage therapy may be an important additional pain management component of the healing experience for patients after thoracic surgery.
    Full-text · Article · Jun 2011 · International Journal of Therapeutic Massage & Bodywork Research Education & Practice
  • [Show abstract] [Hide abstract]
    ABSTRACT: This chapter describes the setup of experiments involving the growth of Chlamydomonas cells in liquid cultures at different oxygen concentrations. The unicellular green alga Chlamydomonas has long been used as a model for the study of nutrient-responsive signal transduction, especially in the context of the function of photosynthetic apparatus. It offers experimental advantages for the study of chloroplast function and biogenesis, photosynthesis, flagellar motility and assembly, photoreceptor biochemistry, and sexual mating. Among these are the ability to manipulate the nuclear and also both organellar genomes; facultative photosynthetic growth because of the ability of Chlamydomonas to use acetate for heterotrophic growth; heterothallic mating types that permit classical genetic approaches for the dissection of important biological problems; and considerable genomic information through EST10 and shotgun genome sequencing projects. This chapter discusses Chlamydomonas as a model organism. Connections between oxygen and copper nutrient homeostasis, concepts related to growth media, culturing, bubbling and flask setup, and other culture conditions besides linking hypoxia and copper-deficient responses through the crr1 mutant are also discussed.
    No preview · Article · Feb 2004 · Methods in Enzymology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Stable RNA, mainly comprised of rRNA and tRNA, accounts for the majority of cellular RNA. Although normally stable under favorable growth conditions in the laboratory, these RNA species undergo extensive degradation responding to many environmental changes and stress conditions. Multiple ribonucleases and other enzymes may be involved in the decay of stable RNA. The onset and rate of degradation are probably determined by the status of the RNA as well as the availability of the degrading activities. The elucidation of pathways for stable RNA decay has been benefited by many biochemical and genetic approaches. These include purification of the enzymes and characterization of their substrate specificity in vitro, and studies of stable RNA decay by inactivating and overexpressing the degradation activities in vivo. Furthermore, RNA degradation intermediates have been characterized in detail, such as determining the sizes, the sequences, the 5′‐ and 3′‐termini, etc. In this work, we describe the methods that are most commonly used in the study of the degradation and processing of stable RNA in E. coli. Most of them should be also useful in studies of other RNA species or RNA from other organisms.
    No preview · Article · Jan 2008
Show more