Articles Offer Insight on Systems-Based Quality Improvement for Neurosurgical Procedures

Newswise — CHARLOTTESVILLE, Va. and ROLLING MEADOWS, Ill. (Nov. 1, 2012) — The November issue of Neurosurgical Focus is dedicated to lessening the number and severity of adverse events surrounding neurosurgical intervention for a variety of disorders. Guest editors Alexander Khalessi, MD (University of California, San Diego); James Forrest Calland, MD (University of Virginia); Gabriel Zada, MD (University of Southern California); and Michael Y. Wang, MD, FAANS (University of Miami Health System), selected 16 articles on systems-based quality improvement for neurosurgical procedures.

The articles are divided into four major subtopics: efforts to improve preoperative, intraoperative and postoperative processes; data validating those efforts in individual institutions; clinical issues and environments particular to neurosurgery as a whole; and issues specific to subspecialty surgeries. Authors from the United States, Germany, Italy, Taiwan and the United Kingdom made contributions to the issue.

The first article in the collection sets up the general problem of adverse events and poses strategies for how to deal with them. Judith Wong, MD, and colleagues reviewed the patterns and frequencies of neurosurgery-related adverse events. They found six categories related to adverse events: surgical technique; perioperative medical management; protocol adherence; preoperative optimization; technology; and communication. On the basis of their review, these authors make five recommendations: a national registry for outcome data and monitoring; standardization of specialized equipment; more widespread subspecialization and regionalization of care; establishment of evidence-based guidelines and protocols; and adoption of the World Health Organization Surgical Safety Checklist within the neurosurgical operating room.

Immediately following this article are a review of neurosurgical checklists; descriptions of the development and use of surgical time-out checklists and safety videos at individual institutions; a discussion of surgical debriefing; and a description of an aviation-based model for incident reporting and investigation.

Additional articles address surgery-related infections and safety issues related to neurophysiological monitoring and intraoperative imaging, and others discuss adverse events specific to shunt surgeries, endovascular procedures, open cerebrovascular operations and intracranial neoplasm surgeries.

Accompanying the November issue of Neurosurgical Focus is an informative and animated podcast interview on neurosurgical risk prevention, in which Dr. Calland speaks with Atul Gawande, MD, author of The New York Times bestseller "The Checklist Manifesto," numerous articles and books on medical error and patient safety, as well as coauthor of five articles in this issue.

Neurosurgical Focus, Vol. 33, No. 5, published online Nov. 1, 2012, online (http://thejns.org/toc/foc/33/5).

Disclosure: Five papers in this issue describe work funded by U.S. Agency for Healthcare Quality and Research Grant 1R18 HS018537-01. Other funding information and potential conflicts of interest are listed at the end of each article.

For additional information, please contact:Ms. Jo Ann M. Eliason, Communications ManagerJournal of Neurosurgery Publishing GroupOne Morton Drive, Suite 200Charlottesville, VA 22903E-mail: [email protected] Telephone (434) 982-1209Fax (434) 924-2702

Neurosurgical Focus, an online-only, monthly, peer-reviewed journal, covers a different neurosurgery-related topic in depth each month and is available free to all readers at www.thejns.org. Enhanced by color images and video clips, each issue constitutes a state-of-the-art “textbook chapter” in the field of neurosurgery. Neurosurgical Focus is one of four monthly journals published by the Journal of Neurosurgery Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons (www.AANS.org), an association dedicated to advancing the specialty of neurological surgery in order to promote the highest quality of patient care.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with nearly 8,200 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves. For more information, visit www.AANS.org.