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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.


Patient age at discharge.Median 58 y (red line). Children < 15 y were transferred to the children’s hospital and registered there.
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pone.0163154.g002: Patient age at discharge.Median 58 y (red line). Children < 15 y were transferred to the children’s hospital and registered there.

Mentions: At discharge, the age distribution was smoothly distributed around the median (58 y, Fig 2). There were one or more surgeries preceding the discharge and the main indications were neurooncology (34%), neurovascular disease (14%), spinal neurosurgery (14%), trauma (12%), cerebrospinal fluid disorder (10%), other (8%), and complications as a separate category of surgical indication (7%, CDG>2). The percentage of spinal interventions is relatively small, which underlines the cranial focus of our department.


A Patient Registry to Improve Patient Safety: Recording General Neurosurgery Complications
Patient age at discharge.Median 58 y (red line). Children < 15 y were transferred to the children’s hospital and registered there.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0163154.g002: Patient age at discharge.Median 58 y (red line). Children < 15 y were transferred to the children’s hospital and registered there.
Mentions: At discharge, the age distribution was smoothly distributed around the median (58 y, Fig 2). There were one or more surgeries preceding the discharge and the main indications were neurooncology (34%), neurovascular disease (14%), spinal neurosurgery (14%), trauma (12%), cerebrospinal fluid disorder (10%), other (8%), and complications as a separate category of surgical indication (7%, CDG>2). The percentage of spinal interventions is relatively small, which underlines the cranial focus of our department.

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, &rho; = -0.3, slope -6 KPS percentage points per increment of CDG) and the length of stay (&rho; = 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.