Center of Excellence in Thoracic Surgery

The COETS program is focused on improving the safety and quality of thoracic patient care worldwide and lowering the overall costs associated with successful treatment. Data from COETS participants will be used to determine which treatment works best for which patient under what circumstances. This information enables clinicians, patients, payors and policymakers to make informed decisions that improve healthcare at the individual level and for the patient population as a whole. The COETS program helps position thoracic surgeons at the forefront of care and demonstrate the improved outcomes and cost savings that result from a quality initiative.

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Program Requirements

1: Institutional Commitment to Excellence

The applicant facility demonstrates a commitment to excellence in thoracic surgery from the highest levels of its medical staff and administration.

This commitment includes having specialty-specific credentialing and privileging guidelines in thoracic surgery.

2: Surgical Experience

The applicant facility performs at least 125 thoracic surgery procedures annually.

Each applicant surgeon has served as the primary surgeon for at least 100 qualifying thoracic surgery procedures annually.

For surgeons, procedures performed at any facility may be used toward volume. Surgeons must have served as the primary surgeon for a procedure to qualify. If the surgeon’s role as primary surgeon has been properly documented, procedures performed during fellowship may qualify. Cases in which the surgeon served as co-surgeon or assisting surgeon do not qualify.

Each procedure used for volume must be thoroughly documented to enable a medical chart review.

Volume waivers may be approved in some circumstances.

Procedures that do not qualify include:

  • Diagnostic procedures
  • Biopsies

3: Physician Program Director

The applicant facility must appoint a Physician Program Director (or Co-Directors) for the Center of Excellence in Thoracic Surgery (COETS) program. The Physician Program Director(s) must:

  • Participate in the relevant decision-making administrative meetings of the facility.
  • Be accredited, or in the process of becoming accredited as a Center of Excellence in Thoracic Surgery (COETS) surgeon.
  • Be primarily responsible for coordinating the multidisciplinary services and systems for thoracic surgery.
  • Participate in multidisciplinary team meetings.

Multidisciplinary team meetings should be held at least quarterly to ensure that decisions related to thoracic surgery are addressed in a comprehensive manner.

4: Consultative Services

The applicant facility must have an intensive care unit and a full complement of consultative services required for the routine and intensive care of thoracic surgery patients and their potential complications.

  • During surgery and until discharge from the post-anesthesia care unit (PACU):
    • Anesthesiologist or certified registered nurse anesthetist (CRNA) who supervises anesthesia delivery on all thoracic surgery patients and is physically present until the patient is discharged from the PACU. Following PACU discharge, the anesthesiologist or CRNA must be available onsite within 30 minutes if needed.
  • Available on site 24/7 (or at all times when patients are present):
    • Physician certified in Advanced Cardiovascular Life Support (ACLS) or equivalent, or an acute response team, at least one of which is ACLS-certified, trained with an established protocol to follow in the event of a sudden respiratory or cardiac event.
  • Available on site within 30 minutes:
    • Cardiologist
    • General Surgeon
    • Physician capable of performing bronchoscopies to diagnose complications
    • Physician with critical care credentials to manage complications, specifically a critical care physician/intensivist, hospitalist, cardiologist or pulmonologist
    • Radiologist
    • Vascular Surgeon
  • Available on site within 60 minutes:
    • Interventional Radiologist
  • Available on site within 24 hours:
    • Infectious disease specialist
    • Oncologist
  • The facility is also able to identify the following consultative staff:
    • Nursing program manager

5: Equipment and Instruments

The applicant facility must maintain a full line of equipment and surgical instruments to provide appropriate perioperative care for thoracic surgery patients. Facilities must have documented training for appropriate staff in the safe operation of this equipment.

If the facility does not have an emergency department or intensive care unit, it must have equipment, such as ventilators and hemodynamic monitoring equipment, necessary to resuscitate and stabilize critically ill patients until they can be transferred to another facility.

6: Surgeon Dedication and Qualified Call Coverage

Each applicant surgeon spends a significant portion of their efforts in the field of thoracic surgery and has active, full privileges in thoracic surgery at the applicant facility.

Each applicant surgeon is board-certified or an active candidate for board certification in their surgical specialty by the highest certifying authority available.

Each applicant surgeon must complete at least 24 hours of continuing medical education (CME) focused on thoracic surgery every three years. Only American Medical Association Physician’s Recognition Award Category 1 Credits or similar credits from a CME accrediting body outside the United States or three national or international meetings qualify.

The applicant facility has policies in place that require all thoracic surgeons to have qualified call coverage, and each applicant surgeon certifies that each covering surgeon is capable of identifying and treating thoracic surgery complications. Each covering surgeon is board-certified or an active candidate for board certification in thoracic surgery by the highest certifying authority available and has admitting privileges at the co-applicant facility.

7: Clinical Pathways and Standardized Operating Procedures

The applicant formally develops and implements clinical pathways that facilitate the standardization of perioperative care for thoracic surgery procedures. The following pathways are required:

  1. Anesthesia, including monitoring and airway management
  2. Deep vein thrombosis (DVT) prevention and management

The first two pathways will be deemed satisfied if the facility has accreditation from The Joint Commission (formerly known as JCAHO), DNV-GL or an equivalent healthcare organization approved by SRC.

  1. Instructions for identification, evaluation and management of early warning signs of complications.
  2. Preoperative patient preparation, evaluation, patient education, consent and plan of action for discharge that includes follow-up and any necessary patient education
  3. Evaluation and plan of action for patients at high risk for malignancy, including when a malignancy is detected
  4. Preoperative multidisciplinary evaluation, education, preparation, admission workup/evaluation and informed consent of the patient
  5. Preoperative pulmonary preparation and long-term postoperative pulmonary patient rehabilitation
  6. Smoking cessation education and support

Each applicant surgeon performs each surgical procedure in a standardized manner as allowed by variations in operative circumstances.

Each applicant surgeon uses a template for operative note dictation that ensures proper collection of data for surgical procedures.

8: Surgical Team and Support Staff

The applicant facility employs nurses and/or physician extenders who provide education and care to patients as well as an operative team trained to care for thoracic surgery patients. The applicant facility also appoints a program coordinator who supervises program development, patient and staff education, multidisciplinary team meetings, and ongoing thoracic surgery program compliance.

The applicant facility provides ongoing, regularly scheduled staff education in-services to ensure applicable staff have a basic understanding of thoracic surgery and the appropriate management of the thoracic surgery patient. In-service topics must include:

  • Signs and symptoms of common postoperative complications
  • Equipment and surgical instruments
  • Clinical pathways

9: Patient Education

The facility and each applicant surgeon must provide all thoracic surgery patients with comprehensive preoperative patient education.

The facility and each applicant surgeon must also have a process for obtaining informed surgical consent and selecting procedures that are most appropriate for each patient’s condition.

10: Continuous Quality Assessment

Each applicant surgeon must collect prospective outcomes data on all patients who undergo thoracic surgery procedures in SRC’s Outcomes Database (or a similar qualifying database) in a manner consistent with applicable patient privacy and confidentiality regulations. This de-identified data must be available to SRC for initial and renewal inspections or upon request.

Program Fees

Initial Fees

Facility Application Fee: $3,975 USD
Surgeon Application Fee: $650 USD

  • Discounts may be available for surgeons that participate in multiple accreditation programs. Contact SRC for details.
  • Upon payment of application fees, applicants achieve Provisional Status and gain access to SRC’s Outcomes Database at no additional charge.

Site Inspection Fees

Domestic Site Inspection Fee (US, Canada, Mexico): $1,850 USD
International Site Inspection Fee: $5,450 USD

  • The site inspection fee covers a one-day inspection with one site inspector and includes one COE program with up to four co-applicant surgeons. A day will be added to the site inspection for every four additional co-applicant surgeons or each additional COE program. Each additional day is $925.
  • Applicant facilities are responsible for arranging and paying for the site inspector’s hotel, ground transportation and, if needed, an interpreter/translator. These items are not included in the standard site inspection fee.
  • Renewal inspections are required every three years to ensure ongoing program compliance.

Annual Fees

Facility Annual Fee: $3,975 USD
Surgeon Annual Fee: $650 USD

  • Annual participation fees will be billed one year after applicants achieve Provisional Status and each year thereafter.

Fees are subject to change without notice and are not refundable. Payment of required fees does not guarantee accreditation.