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Original Articles: General Thoracic

Invited Commentary

Department of Surgery, Wright State University, School of Medicine, One Wyoming St, 7801 WCHE, Dayton, OH 45409

(Email: alex.little{at}wright.edu).

I believe that this important article [1] should encourage two reactions from thoracic surgery groups as follows:

The first response is to acknowledge the importance and value of scrutinizing one's individual and group practice outcomes from a critical eye. So for me, the focus is not so much on the specific quality indicators that were chosen in this report and to quibble whether or not other indicators might be more important or to fault the reporting group for not meeting their own standards. Rather, the message is the value of this type of investment in quality improvement processes by thoracic surgeons. By establishing our own quality standards and then measuring our performance against them, all of us will undoubtedly, as occurred with these authors, find deficiencies. The correction of these deficiencies will improve our outcomes and when collegially reviewed will begin to develop consensus standards for us all. Given that we are dedicated to the best possible outcomes for our patients, this process really has a certain moral imperative.

The second reaction for me is the necessity to look at quality control challenges from a perspective of systems and not a perspective of an individual surgeon or individual healthcare provider. As a result of our individual training and experiences, there is a great deal of individual variety in how we practice our profession. While valuing individual freedom, it has long since been shown that there are some systems of care that function better than others. We must make a commitment to recognizing this, and when evidence supports, for example, the benefit of prophylaxis for deep vein thrombosis, then our practices should mandate and not encourage its use. We must take the lead from this group of nationally recognized leaders in general thoracic surgery and honestly analyze, document, and react to an impartial review of our outcomes and use that information to improve systems and care algorithms, even if it means the painful acknowledgment that one's own habitual techniques are not the best.

	References

Top References

 

1. Cassivi SD, Allen MS, Vanderwaerdt GD, et al. Patient-centered quality indicators for pulmonary resection Ann Thorac Surg 2008;86:927-933.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Alex G. Little Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Little, A. G. Search for Related Content PubMed PubMed Citation Articles by Little, A. G. Related Collections Professional affairs Related Article