A Streamlined Preoperative Surgical Oncology Clinic Workflow Reduces Patient Burden.

BACKGROUND: Although many institutions have focused on improving patient-centered care, little is known about how preoperative workflows affect patients. We hypothesized that a streamlined clinic workflow is associated with decreased cost and time burden on patients. METHODS: A retrospective chart review was performed on surgical oncology patients within thoracic and hepatopancreaticobiliary (HPB) clinics in a tertiary care center from January to December 2016. The clinics varied in scheduling practices, with the thoracic clinic focused on minimizing patient visits. Data collected included number of visits and phone calls made to clinic. Distance traveled, travel cost, and time burden were estimated. RESULTS: We compared 70 esophageal and 60 HPB cancer patients. Thoracic surgery patients required significantly fewer preoperative appointments compared with HPB patients (2.4 versus 4.0; P < 0.00001). About 45 of 60 HPB patients had an extra laboratory work visit, whereas the thoracic clinic incorporated this into clinic visits. The mean distance traveled by patients in the thoracic versus HPB clinic was not significantly different (105.9 versus 93.5 miles; P = 0.44); however, the total cost burden was significantly lower for thoracic patients than HPB patients ($44.0 versus $73.6; P = 0.0029). There was a significant reduction in time burden for patients in the thoracic versus HPB clinic (11.3 versus 18.5 h; P < 0.00001). CONCLUSIONS: This study suggests that a more streamlined preoperative workflow can significantly reduce travel and time burden for patients. The true burden is likely far greater, given potential lost wages and unnecessary stress. Preoperative workflow examination is a promising target for future quality improvement and patient-centered care efforts.

Differentiation of benign and malignant neck pathologies: preliminary experience using spectral computed tomography.

PURPOSE: The objective of this study was to evaluate spectral Hounsfield unit (HU) curves and effective Z (atomic number) generated on dual-energy gemstone spectral imaging computed tomography (CT) in the differentiation of benign and malignant neck pathologic findings. METHODS: This was a retrospective review of 38 patients who underwent neck CT on a gemstone spectral imaging dual-energy CT (Lightspeed CT750 HD 64-slice CT scanner; GE Medical Systems, Milwaukee, Wis) from November 2009 to June 2012 with identifiable masses. One board-certified radiologist placed regions of interest within the mass (19 benign, 19 malignant) and in paraspinal muscles (PSMs) to create 2 spectral HU curves in each patient. The curve parameters compared between the benign and malignant groups included range (conceptually, the difference between the highest and lowest HU), asymptote, decay, and the differences and ratios (of lesion to PSM) of each of these 3 parameters. A logistic regression model was built with these parameters and effective Z. RESULTS: The difference in ranges (between lesion and PSM) was the best predictor of malignancy, with a threshold of 75 or greater demonstrating 95% sensitivity, 89% specificity, and 91.8% area under the curve (AUC). Adding other spectral HU parameters and effective Z to the model did not substantially increase the AUC (93.3%, difference between the 2 models not statistically significant, P > 0.25). The effective Z showed a 79.9% AUC with 68% sensitivity and 68% specificity at an 8.80 cutoff. CONCLUSIONS: The spectral HU curve is promising for differentiating benign and malignant neck pathologic findings, with the difference in range between the lesion and PSM showing the best predictive value.