Enhanced recovery for patients undergoing lung cancer surgery?

We will utilise quality improvement methodologies to design and implement a multimodal, multidisciplinary programme for patients undergoing surgery for lung cancer at this hospital. We will assess the ability of this programme to improve the quality of recovery for these patients. The study will involve five phases: study planning; assessment; alignment; application and measuring. Study planning: This phase will involve finalisation of the study protocol; development of study tools and education of research staff around data collection methods. Ethics and local approvals will also be obtained in this period. Assessment: This phase will involve data collection on all patients admitted following lung cancer surgery to the ICU over a six month period. The aims of this phase are to identify the target patient population; map current workflow and care practices; assess current morbidity rate; assess current intensive care and hospital length of stay for this group; estimate current clinical and economic impact and costs; and identify specific opportunities for improvement. Patients will be invited to participate in a follow-up interview with a research nurse which will assess quality of recovery via a web-based or telephone based interview using the postoperative quality recovery scale (PQRS scale). Alignment:This phase will commence on completion of the assessment phase and will last three months. We will identify and engage core interdisciplinary team members; define Enhance Recovery Programme (ERP) triggers and build checklists; map and test ERP workflow and interventions and communicate the plan to key stakeholders in preparation for the application phase of study. All staff will be trained in the programme and how it will be implemented. During this period, data collected in the assessment phase will be analysed and used as the comparator for the data collected following the application phase to assess the success of the programme. Application: This phase - lasting six months - involves establishing the ERP in this patient population and to complete recruitment and document compliance levels with the ER programme. Patients will be approached by an ERP nurse specialist following referral for surgery and introduced to the programme. All elements of the programme will be instituted and then patients will be invited to participate in a follow-up interview with a research nurse which will assess quality of recovery via a web-based or telephone based interview using the post-operative quality recovery scale. Measuring: In this final phase we will gather morbidity, length of stay and compliance data for the group enrolled to experience ERP. Also, one year follow-up measures of quality of life and recovery will be completed. Measurement and analysis of clinical and economic outcome benefits will compare ER outcomes to programme goals; we will communicate results to the key stakeholders and identify opportunities for improvement, expansion and knowledge translation. Also in this time, a detailed assessment of adherence to the programme and its interventions will be undertaken, analysed and disseminated.