Driving surgical quality improvement through the Lung NODES Project: Riverside Health System's path to compliance with Commission on Cancer Standard 5.8: A multidisciplinary approach to improving pulmonary resection lymphadenectomy compliance highlights the power of communication, education, and collaboration.

Abstract

The Commission on Cancer's Standard 5.8 requires systematic lymph node sampling during curative-intent pulmonary resections to ensure accurate staging and quality surgical care. Following a 2022 accreditation survey in which Riverside Health System did not meet the required 70% compliance threshold, the National Lung NODES Quality Improvement Project was implemented to identify barriers and improve adherence to nodal sampling standards. Baseline data collected in 2023 demonstrated a compliance rate of 56%, with major deficiencies including absent hilar node sampling, inadequate mediastinal node sampling, and inconsistent nodal station labeling. A multidisciplinary quality improvement team consisting of thoracic surgeons, pathologists, operating room staff, and cancer registry personnel was established. Interventions included implementation of dedicated cancer registry data fields for real-time tracking, structured education sessions, case-based feedback loops, and multidisciplinary quality improvement meetings. Emphasis was placed on improving intraoperative communication, specimen documentation, and shared accountability among clinical teams. The initiative resulted in substantial improvement in compliance with Standard 5.8. Through ongoing monitoring, timely feedback, and enhanced collaboration among departments, Riverside Health System exceeded the 80% compliance threshold ahead of the 2025 requirement. Cancer registrars played a central role in data validation and communication of noncompliant cases, enabling rapid process improvement. The project also fostered a culture of multidisciplinary engagement, continuous learning, and standardized practice. A structured multidisciplinary quality improvement initiative significantly improved compliance with systematic lymph node sampling requirements for pulmonary resections. Key factors contributing to success included targeted education, standardized communication, robust data infrastructure, and real-time feedback. Sustained oversight, ongoing monitoring, and continued education of new staff will be essential to maintaining long-term compliance and quality improvement outcomes.