Hospitalists Leading the Way: A Novel, Inter‐Disciplinary Approach to Improve Neurosurgical Patient Outcomes and Care Experiences

Background:

Adverse events are common in the high‐risk work of neurosurgery and improvement of outcomes has been hindered by a lack of resources and time devoted to quality improvement (QI) activities. Because many hospitalists have experience and expertise in leading QI and patient safety initiatives and because neurosurgeons have experience in clinically interfacing with hospitalists via co‐management care models, we hypothesized that an inter‐disciplinary team of hospitalist QI leaders and neurosurgeons could create a University of California (UC) neurosurgery collaborative to improve and reduce the variability of neurosurgical patient outcomes and experiences.

Purpose:

The objective of UC Care Check is to develop an inter‐disciplinary clinical care pathway to improve outcomes for all patients undergoing neurosurgery across all UC Medical Center sites.

Description:

Hospitalist and anesthesiology leaders from each site partnered with neurosurgical chairs and obtained executive sponsorship from CMOs, CNOs, chief quality officers, risk managers, and the UC Office of the President. Working collaboratively through scheduled webinars and site visits, an initial assessment was performed to document the current state of practice at each site, with best practices from each site highlighted for expansion to all sites. Current evidence‐based practices, obtained from performing a comprehensive literature review, and patient‐centered items, obtained from patient focus groups, were included in the development of the intervention. The intervention was refined into a four‐component bundled toolkit (Figure 1) using an iterative process and finalized by all site leads. Components of the toolkit have already been piloted at UC San Francisco, including the use of standard preadmission patient education materials and the use of the ‘Postoperative OR Debrief’. The entire toolkit is being implemented and evaluated in a pre‐post test design between July 2013 and June 2016 at all UC sites (Figure 2). Data collection to assess the impact of UC Care Check is currently underway.

Conclusions:

Hospitalists are at a prime position to not only lead inpatient medicine patient safety and QI initiatives, but can also spearhead surgical specialty system improvement projects leveraging relationships already forged through co‐management models. UC Care Check serves as an example of hospitalists and surgeons collaborating together to raise the neurosurgical quality of care for the UC system by breaking down existing clinical silos and improving patient outcomes.