Page 5 - Summa Health Cancer Institute 2016 Outcomes

Process After identifying the need to improve access to pulmonary consults, the Lung Navigators
began reviewing all scheduled lung screening CT scans at all of Summa Health’s imaging
locations. If a screening report showed an actionable nodule (Lung Rads 4), the navigator
contacted the ordering physicians, suggested a pulmonary referral, and offered to expedite
and coordinate the referral to a pulmonologist within 48 hours. For screenings ordered by a
pulmonologist, the results were communicated to the specialist with an offer to assist with
expediting follow-up testing. If a patient did not meet the recommended 48-hour referral/
consult with a pulmonologist, barriers were identified and attempts were made to improve
them. The steps implemented throughout 2016 to improve access to pulmonary referrals
included creating scheduling reports, improving provider communication through EMR
access for the navigator, primary care physician education, patient education, and improving
the radiologist report structure by emphasizing Lung Rads classification.

Data There were 479 Lung Screening CT scans completed between Jan. 1, 2016, and Oct.
31, 2016. Thirty-seven patients met the Lung Rads 4 criteria for expedited referral to a
pulmonologist. Thirty of the 37 patients (81 percent) had access to the referral/consult in the
recommended 48-hour timeframe. This is a 636 percent improvement compared to 2015.
Sixty-three patients were classified as Lung Rads 3 and will require a six-month follow-up
CT for their positive findings. All patients with positive findings are continually tracked by
the navigators to ensure follow-up occurs. The ordering physician and/or the patients are
notified when follow-up imaging is due. Any barriers to care are addressed by the navigators
as needed.

Data Compared Lahey Hospital in Burlington, MA is considered an industry leader in lung screenings. They
to Guidelines contact providers within two weeks if a pulmonary referral has not been made. Summa
Health far exceeds Lahey’s standards at this time and is meeting the Thoracic Oncology
multidisciplinary team’s recommendation of expediting pulmonary referrals within 48 hours
for Lung Rads 4 findings.

Summary Eighty-one percent of patients with Lung Rads 4 findings have received the recommended
expedited referral to a pulmonologist. The remainder has had delays related to primary care
physician’s preference to manage the patient through PET scan or biopsy, patient’s request
of a delayed consult, and primary care physician’s preference to coordinate appointments
without program assistance.

Action Plan Identified barriers to pulmonary referral are currently being addressed through education
to primary care physicians and patients, as well as increased access to EMR for physician
practices for improved communication.

The Lung Nodule Program will continue to track
pulmonary referrals and continue to attempt
to overcome any barriers that lead to delays in
pulmonary referrals.

Radiation Oncology - American College of Radiology
Summa Health is one of only two major healthcare systems in northeast Ohio to earn the prestigious American College
of Radiology (ACR) accreditation in radiation oncology. This places Summa Health amongst a select group of cancer care
providers nationwide. Accreditation is awarded only to facilities that meet specific practice guidelines and technical standards
developed by ACR after a peer-review evaluation by board-certified radiation oncologists and medical physicists.

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