Neurosurgical Adverse Events and Strategies for Reduction
Neurosurgical Adverse Events and Strategies for Reduction
Neurosurgery is a high-risk specialty currently undertaking the pursuit of systematic approaches to reducing risk and to measuring and improving outcomes. The authors performed a review of patterns and frequencies of adverse events in neurosurgery as background for future efforts directed at the improvement of quality and safety in neurosurgery. They found 6 categories of contributory factors in neurosurgical adverse events, categorizing the events as influenced by issues in surgical technique, perioperative medical management, use of and adherence to protocols, preoperative optimization, technology, and communication. There was a wide distribution of reported occurrence rates for many of the adverse events, in part due to the absence of definitive literature in this area and to the lack of standardized reporting systems. On the basis of their analysis, the authors identified 5 priority recommendations for improving outcomes for neurosurgical patients at a population level: 1) development and implementation of a national registry for outcome data and monitoring; 2) full integration of the WHO Surgical Safety Checklist into the operating room workflow, which improves fundamental aspects of surgical care such as adherence to antibiotic protocols and communication within surgical teams; and 3–5) activity by neurosurgical societies to drive increased standardization for the safety of specialized equipment used by neurosurgeons (3), more widespread regionalization and/or subspecialization (4), and establishment of data-driven guidelines and protocols (5). The fraction of adverse events that might be avoided if proposed strategies to improve practice and decrease variability are fully adopted remains to be determined. The authors hope that this consolidation of what is currently known and practiced in neurosurgery, the application of relevant advances in other fields, and attention to proposed strategies will serve as a basis for informed and concerted efforts to improve outcomes and patient safety in neurosurgery.
Neurosurgery is a high-risk surgical specialty and has begun to pursue systematic approaches to measuring and improving outcomes for the national neurosurgical population. In the other 4 papers in this series, we review the current evidence in 4 distinct areas of neurosurgery concerning the frequency of adverse events in practice and the state of knowledge about how to improve them. Here we describe the patterns revealed from analysis of these data, describe current safety practices in other medical fields, including other surgical specialties, and propose strategies for similar advances in improving safety for neurosurgery. These strategies include process and outcomes monitoring, regionalization and subspecialization, development and dissemination of evidence-based guidelines and protocols, and equipment standardization. We also advocate universal adoption of the WHO Surgical Safety Checklist. Strategic design and development must be followed by a robust systems evaluation and implementation process. We hope this consolidation of what is currently known and practiced in neurosurgery, combined with advances in other fields, will serve as a basis for informed and concerted efforts to improve outcomes and patient safety in neurosurgery.
Abstract and Introduction
Abstract
Neurosurgery is a high-risk specialty currently undertaking the pursuit of systematic approaches to reducing risk and to measuring and improving outcomes. The authors performed a review of patterns and frequencies of adverse events in neurosurgery as background for future efforts directed at the improvement of quality and safety in neurosurgery. They found 6 categories of contributory factors in neurosurgical adverse events, categorizing the events as influenced by issues in surgical technique, perioperative medical management, use of and adherence to protocols, preoperative optimization, technology, and communication. There was a wide distribution of reported occurrence rates for many of the adverse events, in part due to the absence of definitive literature in this area and to the lack of standardized reporting systems. On the basis of their analysis, the authors identified 5 priority recommendations for improving outcomes for neurosurgical patients at a population level: 1) development and implementation of a national registry for outcome data and monitoring; 2) full integration of the WHO Surgical Safety Checklist into the operating room workflow, which improves fundamental aspects of surgical care such as adherence to antibiotic protocols and communication within surgical teams; and 3–5) activity by neurosurgical societies to drive increased standardization for the safety of specialized equipment used by neurosurgeons (3), more widespread regionalization and/or subspecialization (4), and establishment of data-driven guidelines and protocols (5). The fraction of adverse events that might be avoided if proposed strategies to improve practice and decrease variability are fully adopted remains to be determined. The authors hope that this consolidation of what is currently known and practiced in neurosurgery, the application of relevant advances in other fields, and attention to proposed strategies will serve as a basis for informed and concerted efforts to improve outcomes and patient safety in neurosurgery.
Introduction
Neurosurgery is a high-risk surgical specialty and has begun to pursue systematic approaches to measuring and improving outcomes for the national neurosurgical population. In the other 4 papers in this series, we review the current evidence in 4 distinct areas of neurosurgery concerning the frequency of adverse events in practice and the state of knowledge about how to improve them. Here we describe the patterns revealed from analysis of these data, describe current safety practices in other medical fields, including other surgical specialties, and propose strategies for similar advances in improving safety for neurosurgery. These strategies include process and outcomes monitoring, regionalization and subspecialization, development and dissemination of evidence-based guidelines and protocols, and equipment standardization. We also advocate universal adoption of the WHO Surgical Safety Checklist. Strategic design and development must be followed by a robust systems evaluation and implementation process. We hope this consolidation of what is currently known and practiced in neurosurgery, combined with advances in other fields, will serve as a basis for informed and concerted efforts to improve outcomes and patient safety in neurosurgery.