Quality Improvements Specific to Neurosurgery: Local Efforts are Key

In the 15 years since the Institute of Medicine published the ground-breaking report, To Err is Human, the US healthcare system has zeroed in on safety and prevention of medical errors. Despite extensive and innovative efforts, the health care system’s fragmentation is still a barrier to cost-effective quality care and patient satisfaction. Numerous organizations‑‑including the National Quality Forum, the Joint Commission, the US Department of Health and Human Services, and the Centers for Medicare and Medicaid Services‑‑attempt to measure and promote quality with metrics. Regardless, uniform national standards elude us.

A team of neurosurgeons from the University of California, Los Angeles addresses current issues with the health care system and potential initiatives for neurosurgery in an article that appears in the April 2015 issue of Neurosurgery Clinics of North America.

The authors review 4 types of fragmentation:

• Across different patient groups, coverage and access are fragmented
• Over time, care can be fragmented as patients change insurers
• Miscommunication between different hospitals and providers treating the same patient for different diagnoses can fragment care
• During the course of a hospital stay, a patient’s care can be fragmented if different professions fail to communicate

The authors note that much fragmentation can be addressed with local initiatives within individual departments. Neurosurgery, with its history of clinical and technological advances, is well positioned to take leadership roles in safety and quality. The authors highlight several areas that need immediate attention:

• Wrong-site and wrong-patient surgeries, which continue to occur despite tremendous national attention. Neurosurgery has the third highest risk of wrong-site surgeries among all surgical fields.
• Nosocomial infections, which are rare in neurosurgical patients, but have devastating consequences.
• Process improvements, which could improve triage, expedite care, and shorten length of stay.

The authors note that local initiatives will require culture change in many institutions. They conclude with this call to action: “As neurosurgeons, we have the option of being either active leaders or reactionary participants in this movement.”