A clinical audit in a multidisciplinary care path for thoracic surgery: An instrument for continuous quality improvement

Background: Although it is advocated that (major) surgical procedures should be embedded in clinical pathways, the efficacy of such pathways is hardly ever systematically evaluated. The objective of our study was to assess the results of a multidisciplinary care path for patients undergoing thoracic cancer surgery, using a concurrent integrated prospective database. Methods: From April 2006 to December 2008, 169 eligible patients, admitted for thoracic cancer surgery in our institute, gave informed consent to participate in this prospective study. Detailed clinical data concerning patient-, tumour-, treatment- and outcome characteristics were collected. For evaluation of pain and quality of life (QoL), visual analogue scale (VAS) and SF-36 were used respectively. Information retrieved on 94 patients operated in the baseline period (until November 2007) was used in multidisciplinary consensus meetings to develop a new care path. After the introduction of this care path (January 2008) data-collection continued to evaluate outcome using the data of 75 patients operated in the evaluation period (until December 2008). Results: Data from the baseline period showed age (p = 0.001), indication (p = 0.03), postoperative pain (p <0.001) and complications (p