eComment: the Six Sigma approach: from mobile phones to chest tubes.

of increased length of hospitalization on a general thoracic surgery service: a prospective observational study. (Copenhagen, Denmark): Were there any patients in either of the groups where you had to reinsert a tube due to subcutaneous emphysema or pneumothorax after tube removal? Dr. Pompili: No. In this series we had no cases with pneumothorax or other complications after removal of the chest drain. (Copenhagen, Denmark): That's great. I think it is an interesting option, and you are now giving a fixed rate for when the tube can be removed, but is it still the doctor's single decision or is it actually so fixed and so secure that you would even allow the OR medical staff to make the decision on when the tube can be removed? Dr. Pompili: This is a good point, because in this case, unlike a surgical procedure where you have to learn a technical skill, the learning curve is more like a confidence curve. The staff have to have confidence in the safety of the criteria for removing the chest tube. Chest tube removal criteria were decided a priori based on the consensus opinion of major centers with experience in using these digital devices. We think that it is safe to remove a chest tube when the airflow is >40 ml/min. It should be even safer with Thopaz since it shows the graph of airflow in the last 24 h, allowing the detection of higher spikes of air leak. (Copenhagen, Denmark): But it is still the surgeon who looks at the graph and who does the decision-making? Dr. Pompili: The medical staff are in charge of making this decision in our setting. Dr. J. Kuzdzal (Krakow, Poland): You said that there was a difference in the overall cost of treatment in favor of the Thopaz device. Did you also include in this calculation the price of the Thopaz unit itself, which is quite considerable? Dr. Pompili: The calculation is based on the entire hospital stay costs. We found no differences between the costs of the devices. Thopaz is a reuse-able pump, and the cost of consumables for one patient is the same as with traditional devices. Therefore, our cost differences are due mainly to the differences in hospital stay influenced by the duration of chest tube usage. Dr. J. Kuzdzal (Krakow, Poland): But was the cost of the pump itself, which is very high, included in …