Thoracic surgery: Key to success is coordinated care

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Chest is best.

At least that’s what thoracic surgeon, Dr. Robert Zeldin, Head of Thoracic Surgery and Surgical Oncology at Toronto East General Hospital, tells his residents when they ask him why he chose the field.

In a highly specialized field, such as thoracic surgery, there are fewer and fewer hospitals across the country that perform to the level of Toronto East General Hospital (TEGH). This is partially due to the 2005 standards document published by Cancer Care Ontario and the Community of Ontario Thoracic Surgeons, which set forth the criteria as to what institutions should be providing thoracic care, who should be performing surgery and what credentials the surgeons should have. “Research found that complicated surgeries being performed in high volume centres had better outcomes,” says Dr. Zeldin. “Pooling resources delivers quality care to patients and is more efficient and cost effective.”

As one of three Level One hospitals in Toronto with a thoracic program, TEGH performs surgery in great numbers; including 20 major esophageal and 20 mediastinal cases last year and 150 anticipated major lung cases in the new year. The volume doesn’t only mean more patients; it results in more complex cases that require different care.

Whether the team of surgeons are performing an extrapleural pneumonectomy for mesothelioma or a minimally invasive (thorascopic) lobectomy for removing a lung tumour; the key to their ongoing success and expansion is the coordinated care of the group, including anesthetists, nursing staff and RTs, and partnerships between various departments and other hospitals. “We have partnered with other hospitals – Sunnybrook Health Sciences Centre and North York General Hospital,” says Dr. Carmine Simone, Thoracic Surgeon, Medical Director of the ICU and Medical Director of Surgical Inpatient Care. “In doing so, we have a larger network of oncologists, respirologists and so on.”

As a community hospital, TEGH is taking it into their own hands to extend the sphere of care to areas across the Greater Toronto Area (GTA) and Southern Ontario. “There are other centres of excellence,” admits Dr. Zeldin, “but TEGH is special because we have taken the initiative to build this program ourselves.”

Surgeries are performed in partnership with the medical and radiation oncology teams at Sunnybrook Health Sciences Centre. For major surgery, patients are able to receive the highest quality of care for surgery, while being able to return to their community for other services, such as radiology, chemotherapy and physiotherapy. As TEGH and Sunnybrook are the only two hospitals in the GTA functioning this way, it’s a unique approach that is having very positive results. “We hold multidisciplinary clinics where patients can see everyone at the same time; through this we’re coordinating care together quickly,” says Dr. Simone. “Having a very patient focused program, makes a patient’s journey and focus easier.”

Removing a diseased lung or a benign esophageal case for patients with hiatus hernia and reflux disease means that thoracic care is available for TEGH patients in their own community. For others, it means better access to professional treatment and follow ups close to home. “Every case is challenging,” reveals Dr. Zeldin. “Some are very high risk, but we have very grateful patients.”

Dr. Simone adds, “We have one of the best wait times, they’re excellent.” Time between diagnoses and treatment are some of the shortest in the Local Health Integration Network (LHIN). This results in less anxiety and less stress for patients who can transition through the process quickly.

Quality surgical care expands well beyond the operating room. It includes the team and how they work together. “At TEGH, there is a sense of purpose and collegiality – we like each other,” says Dr. Zeldin. “None of us have qualms about leaving our patient care with one another.”

The thoracic team at TEGH is confident it will continue to grow. This will result in better care and quicker treatment for patients requiring thoracic surgery. “We will see an increase in volume and continue to participate in expansion of practice and strengthen our ability to do more partnered care,” says Dr. Simone. With a new surgeon joining the team in 2009, Dr. John Dickie, TEGH is already furthering their knowledge and expertise. The strengthening foundation of the program will mean further benefits for patients in central Ontario.