Knowledge Bank

Background: In high-risk patients, age 50-80 with a smoking history of greater than twenty pack years, lung cancer screening with low-dose computed tomography (LD-CT) is recommended. Thoracic Surgery Advanced Practice Providers (APP), new to lung cancer screening (LCS), will be educated to fill the knowledge gap and evidenced-based practice intervention with the use of a clinical decision support system (CDSS) tool to promote guideline adherence and provide clinical referral pathways.

Objective: To educate APPs on LCS, Lung-RADS guidelines, screening intervals, and implementation of a CDSS tool; evaluate provider adherence to Lung-RADS guidelines in addition to use of the referral pathway; and identify provider barriers to use of guidelines and achieving timely referrals to specialty providers via survey.

Methods: Evidence-based practice (EBP) quality improvement initiative was implemented using the FULD ARCC Model. Retrospective chart audits for data collection prior to implementation for comparison to post-intervention data and pre-and post-education assessment. Qualitative data collection for providers barriers to use of a CDSS tool and timely referrals when indicated.

Results: Pre-education mean, 57.5% and the standard deviation (SD) 12.75. Post-education M= 83.3%, SD =14.4, effect size Cohen's d =1.896764. Pre-intervention patients, n = 31, post-intervention n = 33. Pre-intervention guideline adherence, 87%, SD = 8.85. Post-intervention guideline adherence was 100%, SD of zero, and effect size Cohen's d = 2.076655. Pre-intervention, 25% referral placed, M= 33.3 and SD = 47.140. In the post-intervention data, 75% referral placed, M = 66.67, SD = 47.14, and the effect size Cohen's d = 0.708528.

Conclusion: Provider knowledge of Lung-RADS guidelines and lung improved with the educational seminar in addition, their use of the EBP intervention of a CDSS tool to improve guideline adherence noted a large effect size. The referral rate increased to 75% of patients.