Improving Timeliness in Lung Cancer Diagnosis in the Community Hospital Setting: Implementation of a High-Risk Lung Pathway and Clinic

Background Lung cancer is the deadliest malignancy in the United States, and early identification and diagnosis is crucial to improving patient outcomes. Delays in the diagnosis and treatment of lung nodules are common, and the timely diagnosis of lung nodules suspicious for cancer is critical. Middlesex Health is a community-based health system in Middletown, Connecticut, with a comprehensive Cancer Center that boasts a well-established total lung care center with a full-time dedicated lung nurse navigator. The Cancer Center has a long-established programmatic goal of suspicious lung finding on radiologic imaging to tissue diagnosis time in 28 days or less. In 2017, we determined that this goal was no longer being met.

Objective Improve the timeliness in lung cancer diagnosis in a community hospital setting.

Methods A multidisciplinary, multidepartmental task force team was formed to analyze system processes, contributing factors, and to brainstorm a corrective action plan. A quality improvement model was developed demonstrating all of the components of the Total Lung Care Center that must be reconfigured to make processes more effective. Lewin’s Change Theory was used to guide project implementation. The lung nurse navigator served as the primary change agent.

A Total Lung Care Center medical director, coordinator/nurse navigator, and administrative coordinator were named. A high-risk lung pathway was built. A structure and referral process for high-risk clinic appointment scheduling was developed. The high-risk lung pathway and clinic were implemented and quality data carefully recorded.

Results The average days from suspicious radiologic finding to tissue diagnosis was successfully reduced to well below the goal of 28 days or less.

Conclusion The implementation of a high-risk lung pathway and clinic within a structured Total Lung Care Center program has resulted in the successful improvement in timeliness of lung cancer diagnoses in a community hospital setting. Key components of this model include a dedicated medical director, dedicated nurse navigator/program coordinator, and a multidisciplinary oversight committee. This implementation has resulted in improved patient outcomes, as well as improved patient, family, and staff satisfaction.