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Neurosurgery works to improve quality of care for patients Surgery staff team up with others in UCLA Health System to improve outcomes The UCLA Department of Neurosurgery, under the leadership of Neil Martin, M.D., along with a multidisciplinary group of physicians, housestaff and representatives from Nursing, Care Coordination, Physical Therapy, Support Services, Pharmacy, Radiology, Faculty Practice Group, Hospital Administration and Decision Support have been tackling issues of care coordination and patient throughput. "Given many of the healthcare problems in the U.S. today, our objective is to work diligently toward careful, monitored coordination of care for our neurosurgery patients, who are often some of the highest acuity patients in the hospital. With careful monitoring and real-time-results reporting, we aim to create an environment of total safety, with the highest level of quality and efficiency, and to become the model service for every hospital in the country," states Dr. Martin. To significantly improve efficiency in discharge planning, the team implemented the "discharge before noon" process. Patient education is now given the night before discharge by the evening shift nurse. Also, advanced planning of the discharge begins the day before versus the day of, allowing patients to be discharged before noon. The process has allowed for more new patients awaiting critical neurosurgical procedures to be admitted without being delayed or canceled due to unavailable beds. By coordinating multiple services to achieve this turn-around time, staff, patients and families are happier and more satisfied. "I have really enjoyed working with the multidisciplinary neurosurgery team in their efforts to improve the quality of care for our patients. The collaboration of this group is incredible, and a testament to what we all can accomplish when we bring clinical and operational representation together to work on common goals," notes Janet Rimicci, director of operations. The Neurosurgery ICU Quality sub-group, led by neurosurgeon Paul Vespa, M.D., is currently focusing on ways to eradicate hospital-acquired infections, medicationmanagement errors, and to improve ICU quality outcomes. Dr. Vespa and his team have developed methods for tracking and ensuring bundle compliance, to track the implementation of evidence-based medicine into practice. Each of the measured neuro bundles is broken into separate components. Should one aspect of the bundle not get done, the bundle as a whole fails. A "metrics dashboard" was developed to track and evaluate progress. The group chose certain areas consistent with national patient-safety goals they want to improve, such as patient satisfaction, bundle compliance, infection rates, discharge before noon, outpatient access, increased productivity and cost savings associated with high-end supply costs. The dashboard will be placed on the UCLA MedNet Dashboard site and disseminated to staff on a routine basis.
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