The following is a summary of “Clinical Experience With a Dedicated Neurocritical Care Quality Improvement Program in an Academic Medical Center,” published in the January 2024 issue of Pain by Lele et al.
Researchers conducted a retrospective study to outline the structure, processes, and results of a Neurocritical Care Quality Improvement Program (NCC-QIP) at Harborview Medical Center, a quaternary academic medical center in the United States.
They elucidated the evolution and implementation of the NCC-QIP, detailing its framework, operational aspects, hurdles encountered, and evolutionary trajectory. They scrutinize their performance concerning various NCC-QI quality metrics outlined by the Joint Commission, the American Association of Neurology, and the Neurocritical Care Society. Additionally, they assess self-reported QI issues and initiatives prompted by insights from event/measurement reporting for admitted patients (January 1, 2014- June 30, 2023).
The results showed that of 20,218 patients reviewed by the NCC-QI, the mean age was 57.9 years (standard deviation: 18.1), with 56% males (n=11,326). The distribution of diagnoses included acute ischemic stroke (AIS; 22.3%, n=4506) cases, spontaneous intracerebral hemorrhage (ICH; 14.8%, n=2996), spontaneous subarachnoid hemorrhage (SAH; 8.9%, n=1804), and traumatic brain injury (TBI; 16.6%, n=3352), among others. Mechanical ventilation was required for 37.4% (n=7,559) of patients, while 13.6% (n=2,753) received intracranial pressure monitoring. The median lengths of stay were two days in the intensive care unit (Quartile 1-Quartile 3: 2-5 days) and seven days in the hospital (Quartile 1-Quartile 3: 3-14 days). Discharge to home was observed in 53.9% (n=10,907) of cases, with a mortality rate of 11.4% (n=2,309). The top three QI concerns were related to care coordination/communication/handoff (40.4%, n=283), medication (14.9%, n=104), and equipment/devices (11.7%, n=82). Hospital-acquired infections included ventilator-associated pneumonia (16.3%, n=419/2562), ventriculostomy catheter-associated infections (4%, n=102/2246), and deep venous thrombosis/pulmonary embolism (3.2%, n=647). Quality metrics documentation rates were as follows: nimodipine after SAH (99.8%, 1802/1810), Hunt and Hess score (36%, n=650/1804), ICH score (58.4%, n=1752/2996), and National Institute of Health Stroke Scale for AIS patients (72%, n=3244/4506). Admission Glasgow Coma Score was recorded in 99% of patients with SAH, ICH, and TBI. Educational modules were introduced in response to event reporting.
Investigators concluded that a dedicated NCC-QIP at quaternary medical centers could effectively monitor large patient volumes, identify common concerns (communication, medication, equipment), and improve quality through education despite data abstraction challenges.
