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A Patient Registry to Improve Patient Safety: Recording General Neurosurgery Complications

View Article: PubMed Central - PubMed

ABSTRACT

Background: To improve the transparency of the local health care system, treatment cost was recently referenced to disease related groups. Treatment quality must be legally documented in a patient registry, in particular for the highly specialized treatments provided by neurosurgery departments.

Methods: In 2013 we have installed a patient registry focused on cranial neurosurgery. Surgeries are characterized by indication, treatment, location and other specific neurosurgical parameters. Preoperative state and postoperative outcome are recorded prospectively using neurological and sociological scales. Complications are graded by their severity in a therapy-oriented complication score system (Clavien-Dindo-Grading system, CDG). Results are presented at the monthly clinical staff meeting.

Results: Data acquisition compatible with the clinic workflow permitted to include all eligible patients into the registry. Until December 2015, we have registered 2880 patients that were treated in 3959 surgeries and 8528 consultations. Since the registry is fully operational (August 2014), we have registered 325 complications on 1341 patient discharge forms (24%). In 64% of these complications, no or only pharmacological treatment was required. At discharge, there was a clear correlation of the severity of the complication and the Karnofsky Performance Status (KPS, ρ = -0.3, slope -6 KPS percentage points per increment of CDG) and the length of stay (ρ = 0.4, slope 1.5 days per increment of CDG).

Conclusions: While the therapy-oriented complication scores correlate reasonably well with outcome and length of stay, they do not account for new deficits that cannot be treated. Outcome grading and complication severity grading thus serve a complimentary purpose. Overall, the registry serves to streamline and to complete information flow in the clinic, to identify complication rates and trends early for the internal quality monitoring and communication with patients. Conversely, the registry influences clinical practice in that it demands rigorous documentation and standard operating procedures.

No MeSH data available.


Cumulative sum of case report forms (CRFs) for patients, admissions, surgeries, discharges and follow-ups.Complications registered at discharge (black line).
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pone.0163154.g001: Cumulative sum of case report forms (CRFs) for patients, admissions, surgeries, discharges and follow-ups.Complications registered at discharge (black line).

Mentions: Fig 1 shows the number of CRFs in the patient registry since its inception. The inclusion of surgeries (sCRF) has proceeded at a regular rate starting from 2014. The number of discharges (dCRF) increases also linearly, albeit at a somewhat lower rate. The lower rate reflects the fact that some patients are operated on several times before discharge and not all patients are discharged from the ward of our department. Registering the surgical interventions and the outcome at discharge was the primary goal during the first months of the implementation of the patient registry. Follow-up visits were registered on a regular basis starting only from 2014 on after changing to filemaker®. The slope of the follow-up curve exceeds that of the discharge curve, because several patients appear at several follow-ups. Admissions (aCRF) were included starting summer 2014 and increase in parallel with the discharge curve. The small numbers of admissions and follow-ups before the regular registration were entered from the electronic patient records (KIS) for research projects on select patient groups. From August 2014 on, all dCRF were completed with at least a KPS score. Until the end of 2015 we have registered 2880 patients that were treated in 3959 surgeries and 8528 consultations.


A Patient Registry to Improve Patient Safety: Recording General Neurosurgery Complications
Cumulative sum of case report forms (CRFs) for patients, admissions, surgeries, discharges and follow-ups.Complications registered at discharge (black line).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036891&req=5

pone.0163154.g001: Cumulative sum of case report forms (CRFs) for patients, admissions, surgeries, discharges and follow-ups.Complications registered at discharge (black line).
Mentions: Fig 1 shows the number of CRFs in the patient registry since its inception. The inclusion of surgeries (sCRF) has proceeded at a regular rate starting from 2014. The number of discharges (dCRF) increases also linearly, albeit at a somewhat lower rate. The lower rate reflects the fact that some patients are operated on several times before discharge and not all patients are discharged from the ward of our department. Registering the surgical interventions and the outcome at discharge was the primary goal during the first months of the implementation of the patient registry. Follow-up visits were registered on a regular basis starting only from 2014 on after changing to filemaker®. The slope of the follow-up curve exceeds that of the discharge curve, because several patients appear at several follow-ups. Admissions (aCRF) were included starting summer 2014 and increase in parallel with the discharge curve. The small numbers of admissions and follow-ups before the regular registration were entered from the electronic patient records (KIS) for research projects on select patient groups. From August 2014 on, all dCRF were completed with at least a KPS score. Until the end of 2015 we have registered 2880 patients that were treated in 3959 surgeries and 8528 consultations.

View Article: PubMed Central - PubMed

ABSTRACT

Background: To improve the transparency of the local health care system, treatment cost was recently referenced to disease related groups. Treatment quality must be legally documented in a patient registry, in particular for the highly specialized treatments provided by neurosurgery departments.

Methods: In 2013 we have installed a patient registry focused on cranial neurosurgery. Surgeries are characterized by indication, treatment, location and other specific neurosurgical parameters. Preoperative state and postoperative outcome are recorded prospectively using neurological and sociological scales. Complications are graded by their severity in a therapy-oriented complication score system (Clavien-Dindo-Grading system, CDG). Results are presented at the monthly clinical staff meeting.

Results: Data acquisition compatible with the clinic workflow permitted to include all eligible patients into the registry. Until December 2015, we have registered 2880 patients that were treated in 3959 surgeries and 8528 consultations. Since the registry is fully operational (August 2014), we have registered 325 complications on 1341 patient discharge forms (24%). In 64% of these complications, no or only pharmacological treatment was required. At discharge, there was a clear correlation of the severity of the complication and the Karnofsky Performance Status (KPS, ρ = -0.3, slope -6 KPS percentage points per increment of CDG) and the length of stay (ρ = 0.4, slope 1.5 days per increment of CDG).

Conclusions: While the therapy-oriented complication scores correlate reasonably well with outcome and length of stay, they do not account for new deficits that cannot be treated. Outcome grading and complication severity grading thus serve a complimentary purpose. Overall, the registry serves to streamline and to complete information flow in the clinic, to identify complication rates and trends early for the internal quality monitoring and communication with patients. Conversely, the registry influences clinical practice in that it demands rigorous documentation and standard operating procedures.

No MeSH data available.