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AANS Neurosurgeon | Volume 25, Number 4, 2016

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NPA-IHI Readmissions and Length of Stay Study

The NeuroPoint Alliance (NPA) and the Institute for Healthcare Improvement (IHI) launched a pilot test from January-July 2017 for eight Quality Outcomes Database (QOD) registry participants that functioned as the QOD Spine Surgery Learning Community (SSLC). Participating centers included Atlantic Neurosurgical Specialists, Carolina Neurosurgery and Spine Associates, Goodman-Campbell Brain and Spine, Norton Healthcare, Semmes-Murphey Brain and Spine, the University of California at San Francisco, the University of Utah and Vanderbilt University. The objectives of the project included the testing of change theories that emerged from the research and development stage conducted from October-December 2016. 

NPA’s surgeon leadership team, led by Anthony L. Asher, MD, FAANS, and Mohamad Bydon, MD, selected two main targets for the improvement work: readmissions and length of stay for lumbar spine fusion levels 1-3 surgeries. The SSLC was then tasked with testing a subset of change ideas from a driver diagram using multiple rapid-cycle tests, building improvement capability among participating sites and sharing in a facilitated learning community. Over the past six months, the pilot site teams have been actively testing four primary change ideas from the driver diagram: 1) preoperative discharge planning; 2) screening for comorbidities and risks prior to surgery; 3) assessing pain and satisfaction at discharge; and 4) postoperative calls two to five days after discharge. For the changes that were shown to be successful on a small scale in the SSLC sites, the NPA leadership team will conduct larger scale testing and implementation. Successful implementation of improvement concepts in provider systems will ultimately depend on the capacity and capabilities of local teams to embed improvement activities into their management infrastructure.

At the conclusion of the pilot in July, the IHI project team offered several key recommendations to NPA leadership that are focused on sustaining existing changes among the SSLC participants. Those are to expand the target population, spread promising practices to other QOD sites, extend testing to new areas of focus from the project driver diagram and reliably collect real-time data for designated improvement measures. NPA’s leadership is considering the next stages to support the pilot sites in sustaining their early gains while planning for further dissemination of effective improvements.

 

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