Does Non-Placement of a Drain in Breast Surgery Increase the Rate of Complications and Revisions?

Purpose: Although surgical therapy for breast cancer has become less radical, intrasurgical placement of drains and the use of compression bandages is still standard practice. However, evidence for the clinical benefit of wound drains is controversial, and use of drains is associated with increased pain and longer hospital stays. This raises the question whether, given the latest surgical techniques, wound drainage is still medically necessary. Material and Method: A retrospective analysis was done of patients with breast cancer treated surgically between January 2009 and April 2012 in the Breast Centre Hohenlohe (n = 573). Complication rates and revision following surgery with and without placement of wound drains were compared for patients who had breast-conserving surgery (n = 425) and patients who underwent mastectomy (n = 148). Results: The baseline characteristics (age, number of resected lymph nodes, numbers of patients who had sentinel lymph node resection, tumour characteristics, receptor status and affected side) were comparable for the investigated patient groups. The overall rate of complications was 4 %. There was no significant difference with regard to complication rates after surgery with and without placement of wound drains between the group of patients with breast-conserving surgery and the group of patients with mastectomy (p = 0.68 and p = 0.54, respectively). Conclusion: Our data indicate that non-placement of a wound drain does not influence complication or revision rates after breast-conserving surgery or mastectomy.

SU-E-T-222: How to Define and Manage Quality Metrics in Radiation Oncology.

PURPOSE: Since the 2001 IOM Report Crossing the Quality Chasm: A New Health System for the 21st Century, the need to provide quality metrics in health care has increased. Quality metrics have yet to be defined for the field of radiation oncology. This study represents one institutes initial efforts defining and measuring quality metrics using our electronic medical record and verify system(EMR) as a primary data collection tool. This effort began by selecting meaningful quality metrics rooted in the IOM definition of quality (safe, timely, efficient, effective, equitable and patient-centered care) that were also measurable targets based on current data input and workflow. METHODS: Elekta MOSAIQ 2.30.04D1 was used to generate reports on the number of Special Physics Consults(SPC) charged as a surrogate for treatment complexity, daily patient time in department(DTP) as a measure of efficiency and timeliness, and time from CT-simulation to first LINAC appointment(STL). The number of IMRT QAs delivered in the department was also analyzed to assess complexity. RESULTS: Although initial MOSAIQ reports were easily generated, the data needed to be assessed and adjusted for outliers. Patients with delays outside of radiation oncology such as chemotherapy or surgery were excluded from STL data. We found an average STL of six days for all CT-simulated patients and an average DTP of 52 minutes total time, with 23 minutes in the LINAC vault. Annually, 7.3% of all patient require additional physics support indicated by SPC. CONCLUSIONS: Utilizing our EMR, an entire year's worth of useful data characterizing our clinical experience was analyzed in less than one day. Having baseline quality metrics is necessary to improve patient care. Future plans include dissecting this data into more specific categories such as IMRT DTP, workflow timing following CT-simulation, beam-on hours, chart review outcomes, and dosimetric quality indicators.

Congestive heart failure clinical outcomes study in a private community medical group.

BACKGROUND: Although angiotensin-converting enzyme (ACE) inhibitor therapy has been shown to improve clinical outcomes of patients with systolic dysfunction, it has been underused or prescribed in inadequate dosages by physicians in the treatment of congestive heart failure. Our goal was to evaluate whether integration of a clinical guideline within a continuous quality improvement program would improve care for patients with congestive heart failure caused by systolic dysfunction. METHODS: All patients of a private community medical group who were admitted to the hospital with congestive heart failure were studied prospectively for 21 months. An internally developed congestive heart failure practice guideline was presented to the group's physicians. The guidelines were available in the hospital computer system and were reinforced at monthly quality improvement meetings. Performance data were reviewed quarterly with the physicians. RESULTS: Rates of classifying systolic vs diastolic dysfunction remained unchanged during the study. Use of ACE inhibitor therapy at the time of discharge improved substantially for patients with systolic dysfunction. Quarterly admissions of patients with systolic dysfunction declined 49% throughout the study period. No improvement was noted in the documentation of specific discharge instructions. CONCLUSIONS: Use of a disease management guideline, ongoing physician education, and feedback of peer performance data to physicians significantly improved the quality and efficiency of care provided to patients with congestive heart failure in an independent, primary care medical group.