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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.


Complications at discharge.(A) Distribution of severity in the Clavien Dindo classification system CDG. (B) Karnofsky Performances Status Scale (KPS) as a function of severity of the complications (ρ = -0.3, slope -6 KPS percentage points per increment of CDG). (C) Duration of hospital stay after surgery (ρ = 0.4, slope 1.5 days per increment of CDG). (D) Distribution of KPS for patients with and without complications (adverse event AE).
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pone.0163154.g003: Complications at discharge.(A) Distribution of severity in the Clavien Dindo classification system CDG. (B) Karnofsky Performances Status Scale (KPS) as a function of severity of the complications (ρ = -0.3, slope -6 KPS percentage points per increment of CDG). (C) Duration of hospital stay after surgery (ρ = 0.4, slope 1.5 days per increment of CDG). (D) Distribution of KPS for patients with and without complications (adverse event AE).

Mentions: Fig 3A shows the distribution of the 325 complications registered at discharge since August 2014. The majority of complications (217/325 = 67% CI [61% 72%]) were treated without invasive treatment (CDG 1 and CDG 2). Eleven patients died within 30 days of surgery (CDG 5). CDG 1 was marked in 72 (22% CI [18% 27%]) patients, including those with a focal neurological deficit, which was not treated and improved in some patients after discharge with the passage of time. An additional surgical intervention under general anaesthesia was required in 67 (21% CI [16% 25%]) patients before discharge (CDG 3b). The distributions vary between patient groups and depend also on the preoperative state of the patient, which is not considered here.


A Patient Registry to Improve Patient Safety: Recording General Neurosurgery Complications
Complications at discharge.(A) Distribution of severity in the Clavien Dindo classification system CDG. (B) Karnofsky Performances Status Scale (KPS) as a function of severity of the complications (ρ = -0.3, slope -6 KPS percentage points per increment of CDG). (C) Duration of hospital stay after surgery (ρ = 0.4, slope 1.5 days per increment of CDG). (D) Distribution of KPS for patients with and without complications (adverse event AE).
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5036891&req=5

pone.0163154.g003: Complications at discharge.(A) Distribution of severity in the Clavien Dindo classification system CDG. (B) Karnofsky Performances Status Scale (KPS) as a function of severity of the complications (ρ = -0.3, slope -6 KPS percentage points per increment of CDG). (C) Duration of hospital stay after surgery (ρ = 0.4, slope 1.5 days per increment of CDG). (D) Distribution of KPS for patients with and without complications (adverse event AE).
Mentions: Fig 3A shows the distribution of the 325 complications registered at discharge since August 2014. The majority of complications (217/325 = 67% CI [61% 72%]) were treated without invasive treatment (CDG 1 and CDG 2). Eleven patients died within 30 days of surgery (CDG 5). CDG 1 was marked in 72 (22% CI [18% 27%]) patients, including those with a focal neurological deficit, which was not treated and improved in some patients after discharge with the passage of time. An additional surgical intervention under general anaesthesia was required in 67 (21% CI [16% 25%]) patients before discharge (CDG 3b). The distributions vary between patient groups and depend also on the preoperative state of the patient, which is not considered here.

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.