45.09 Efficiency Quality Index in Thoracic Surgery – Developing a Quality Assessment Tool Scoring System

Posted on May 12, 2025

K. Duquette2, M. Maxfield1,2, K. Uy1,2, F. Lou1,2, I.C. Emmerick1,2  1UMass Memorial Healthcare, Thoracic Surgery, Worcester, MA, USA 2UMass Chan Medical School, Worcester, MA, USA

Introduction:
This study aims to develop an Efficiency Quality Index (EQI) to summarize and monitor the quality of care provided at a thoracic surgery division.

Methods:
The EQI comprised fourteen indicators (IND), including OR Time Incision to Close, Total OR Time, Observed vs Expected Discharge, Rate of Discharge After 72 Hours, Readmission, Surgical Site Infection, 30-Day Mortality, OR Transfusions, Emergent Conversions, Pneumonia, Unanticipated Post-Op Procedure, Major Complication, Prolonged Air Leak, and Compliance with the ≥three N2 and one N1 Nodal Station Dissections. A total of 100 points were distributed among the fourteen INDs, determining a maximum number of points (MaxP) per IND, ranging from 4 to 16 points. The thoracic surgeons validated this allocation. A quarterly EQI was calculated considering a cohort of minimally invasive lobectomies performed from January 2019 to June 2023. To calculate the EQI, each IND was obtained, and its points were attributed considering how they compared with internal benchmarks and derived from the Society of Thoracic Surgeons (STS). The allocation of the MaxP in each IND was performed in increments of 25%. Therefore, to obtain the MaxP, the IND value should be in the third quartile of the benchmark distribution.?This corresponds to a total score of 80.

Results:
EQI varied from 54.8 (Q3-2020) to 95.2 (Q2-2022) (Figure.1). For each quarter, we identified the IND contributing to the lower performance and triggered actions to improve quality. The weight with a "point system" determined by the surgeons considering each component's importance gave the EQI the representation needed from the provider's perspective.

Conclusion:
Our EQI, developed and validated by surgeons to monitor trends over time, can help streamline quality assessment and actions required to improve quality in aspects that are relevant to clinical practice.