DEVELOPMENT AND IMPLEMENTATION OF A LUNG NODULE PROGRAMDEVELOPMENT AND IMPLEMENTATION OF A LUNG NODULE PROGRAMTamra Kelly, BS RRT-NPS, Gary B. Mertens, RCP, CPFT, Jenifer Beasley, RRT, Tamra Kelly, BS RRT-NPS, Gary B. Mertens, RCP, CPFT, Jenifer Beasley, RRT,

Departments of Cancer Services and Cardiopulmonary Services, Sutter Roseville Departments of Cancer Services and Cardiopulmonary Services, Sutter Roseville Medical Center (SRMC)Medical Center (SRMC)

The presenter has no conflicts of interest. There was no research funding, sponsorship, or research support for this work.

 BackgroundThe 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. 

MethodsThe 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.

ResultsOpened 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.

ConclusionImplementation 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.

Data

PDSA Model For ImprovementPlan

Implement collaborative interprofessional Lung Nodule program to diagnose and treat Lung Nodules at an earlier stage.

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

Study Tracking nodules based on size, repeat imaging based on NCCN guidelines, obtaining tissue for diagnosis as indicated, tracking stage at diagnosis etc.

Act The process is evolving as we monitor our data and receive input from stakeholders. Screening CT program implemented Sept 2014.

Tools