PURPOSE
Lung cancer is the leading cause of cancer deaths in Hawaii and throughout the United States. In 2022, Hawaii ranked dead last in the nation in early detection. Early detection of lung cancer allows for more treatment options and as a result increases overall 5-year survival. We strive to create a comprehensive pulmonary nodule clinic that provides timely evaluation, accurate diagnosis and appropriate management with a focus on early detection. Our clinic will be unique in our State as we have the manpower necessary to staff a multi-disciplinary team, including thoracic surgery, diagnostic and interventional pulmonary, radiology with the sole focus of

1. Early detection. The main benefit and the cornerstone of our nodule clinic will be early detection. Early detection allows for a wide range of treatment options, including lung-sparing surgery for early stage lung cancer. Identification of lung cancer at an early stage is associated with a much higher five-year survival rate. Hawaii ranked last in early detection at 20% nationally. We would like Hawaii to be ranked first nationally in early detection within 5 years.
2. Referral Guidelines.
   
   • In general, we will not refuse referrals to our nodule program. Hopefully this will encourage primary care providers to send patients earlier rather than later.
   • Within our healthcare system, we will identify pulmonary nodules via internal referrals as well as utilizing artificial intelligence software, such as Optellum, to identify nodules greater than or equal to 6 mm in size.
   • Direct communication channels: We will have a single phone number, fax number, email address dedicated to receiving referrals. These channels will be easily accessible and regularly monitored.
   • Referral forms and templates. We will use pre-existing referral forms/templates. We encourage including a CT scan of the chest with the referral.
3. Streamlined Triage process: Nurse coordinator will review incoming referrals and probably triage the case if necessary to multidisciplinary rounds. Cases will be reviewed weekly by multidisciplinary group of physicians. Subsequently each case will be triaged and seen in a timely fashion. High acuity, time sensitive cases will be seen by a physician within 1 week and prioritized to receive rapid diagnostic and therapeutic procedures. Clear communication will also take place in regards to our decision-making process.
   
   • Priority referrals:
     
     • Referrals from medical oncology, radiation oncology, thoracic surgery will be reviewed on a priority basis.
     • Nodule size > 1 cm, hypermetabolic nodules, growth pattern consistent with neoplasm
     • Calculated risk for malignancy, smoking history, oncologic history, family history, exposure history will be taken into consideration during the triage process
4. Clear communication and feedback loop: Once a decision has been made, nurse coordinator will communicate with the patient as well as the referring physician’s staff. Progress Notes, procedures and laboratory results will be shared on a timely basis with the referring provider.