Chapter
Section 1: The Importance of Quality and Safety in Neurosurgery
Chapter 1: The Many Perspectives of Quality and Safety in Neurosurgery
Allied Health Professionals
Chapter 2: The History and Future of Quality and Safety in Neurosurgery
Introduction: The Perspective From Patient Safety Science
Training for Safety in Neurosurgery
Simulation Training in Neurosurgery
Reporting of Adverse Events in Neurosurgery
Data in the Service of Clinical Practice
Creating a Safety Culture in Neurosurgery
Regionalization and Subspecialization
Neurosurgery Journals and Clinical Practice Guidelines
Chapter 3: Clinical Research in Quality Improvement: Complementary Approaches to Improving Neurosurgical Practice
An Example From Clinical Practice
The Fundamental Characteristic of Clinical Research
The Fundamental Characteristic of Process Improvement
How to Distinguish Clinical Research From Process Improvement
Section 2: Measuring and Improving Performance
Chapter 4: On Developing the Tools and Metrics for a Neurosurgical Quality Program
Initiatives, Metrics, and Benchmarks
UTSW Division of Pediatric Neurosurgery
Chapter 5: The Role of Clinical Registries in Health Care
Health Care Reform in the United States
The Role of Registries in the Contemporary Health Care Environment
Implications for Neurosurgeons
Value-Based Purchasing and Quality Reporting
Successful National Registries
The Quality Outcomes Database
The Randomized Registry Trial
Current Challenges in Registry Implementation and Data Collection
Chapter 6: Measuring Value of Health Care: The Importance and Challenges of Measuring True Cost
What Is Value in Health Care?
Health Care Quality Components and How They Are Measured
Access: “Make My Care Available and Affordable”
Respect: “Respect Me as a Person Not a Case”
Outcome: “Make Me Better”
Cost Definition and How It Is Measured
Time-Driven Activity-Based Costing
The Cost Measurement Process Itself: TDABC Step by Step
Challenges of Health Care Costing and Three Myths
Chapter 7: Teams, Competence, and Safety in Surgery
What Is a Team and What Does It Do?
Characteristics of Effective Team Members
Team Behavior and Surgical Outcomes
The System(s) in Which Teams Work
Influencing for Good or Ill—The System's Culture
Teams and Culture—Nontechnical Skill Assessment
Culture and Nontechnical Skill Performance
Chapter 8: Evidence-Based Practice of Neurosurgery: Implications for Quality and Safety
Understanding Variation: Noise and Bias
The Role of Process Improvement, Quality, and Safety Projects in Evidence and Evidence-Based Practice
Problems in an Evidence-Based Practice
Readings on Evidence-Based Practice
Chapter 9: The Physician Handoff and Its Role in Quality and Safety
Central Role of the Handoff in Health Care, Focus on Improvement
Barriers to Handoff Performance, Handoff Education, and Outcomes
The Essence of the Handoff
Section 3: The Practice of Quality and Safety in Neurosurgery
Chapter 10: Improving Operating Room Safety
Volume-Outcome Relationships and Systems Thinking
Neuronavigation and Intraoperative Imaging
Intraoperative Electrophysiology
Chapter 11: Using Multicenter Clinical Registries to Improve Outcomes
History of Clinical Registries
How Do Registries Improve Outcomes?
Gathering Relevant Epidemiologic and Clinical Data
Setting Benchmarks and Standards
Postmarketing Surveillance of Medical Devices
Establishment of Guidelines
Implementation of Guidelines Within Registries
Participation in Data Collection May Improve Outcome
Comparison of RCT and Registry-Based Research
Sample Size and Statistical Power
Relative Appropriateness for RCTs and Registry-Based Research for Specific Clinical Questions
Detection of Variation in Clinical Practice
Registry-Based Research: Special Considerations and Limitations
Ethical, Legal, Confidentiality, and Governance Issues
Data Collection Methodology
Study Design Considerations
Statistical Considerations
Registry-Based Randomized Trials
Examples of Clinical Registries in Neurosurgery
Patient-Reported Outcomes
Chapter 12: Improving Efficiency and Mapping Surgical Procedures Using Lean Methods
Chapter 13: Quality Efforts for Reducing Mortality in Neurosurgery
Measuring the Success of Quality Initiatives: Quantifying Mortality
University Health System Consortium Data
Reducing Overall Mortality of All Hospital Patients
Collaboration and Standardization of Care
Electronic Medical Record
National Quality Databases
Reducing Mortality on Neurosurgical Services
Mortality in Neurosurgery
Neurosurgical Quality Improvement Initiatives
DUMC Neurosurgical Quality Improvement: A Single Institutional Review
Application to Other Neurosurgical Departments
Chapter 14: Reducing Readmissions
Importance of Readmissions
Methods to Reduce Readmissions
Readmission Data Collection and Analysis
Chapter 15: Improving Outcomes: Big Data and Predictive Analytics
Computational Neurosurgery Outcomes Center
Big Data and Predictive Analytics
Patient-Reported Outcomes
Chapter 16: Improving Performance by Improving Education
Education of Fundamental Medical and Surgical Knowledge
Education of QI Techniques and Processes
Value Improvement in Resident Training in a University Environment
Measuring Educational Outcomes
Education of Physician Well-Being
Chapter 17: Improving Outcomes With Subspecialization and Regionalization
Provider Volume-Outcomes Relationship
Efficiency of Training and Simulation
Chapter 18: Quality of Care and Outcomes in Pediatric Neurosurgery: Incorporating Evidence-Based Practice
Validated Outcome Measures
The Pediatric Quality-of-Life Inventory
Health Utilities Index Mark 3 (HUI3)
Disease-Specific Outcome Measures
Hydrocephalus Outcome Questionnaire
The Chicago Chiari Outcomes Scale
Chiari Health Index for Pediatrics
The Quality of Life in Childhood Epilepsy Questionnaire
Pediatric Functional Assessment of Cancer Therapy Questionnaire in Brain Tumor Survivor (pedsFACT-BrS)
Chapter 19: Eliminating Unnecessary Diagnostic Imaging and Labs
Chapter 20: Creating National Practice Standards Through Collaboration
Best Practice Protocols and Checklists
Collaboration Through Registries and Database Research
Chapter 21: Use of Risk Model for Assessment of Resident Perception of Surgical Complexity and Evaluation of Procedural C ...
Current Educational Paradigm, Without Granularity of Resident Education
Limitations and How a Program Might Use This Methodology
Chapter 22: Use of a Physical Education and Nutrition Program to Improve Outcomes
Deterioration of Personal Health During Residency Training
Burnout and Resident Attrition
Exercise Effects on Sleep, Distress, and Fatigue
Benefits of a Balanced Lifestyle in Physicians and Trainees
The MUSC Pilot Initiative
Physical Fitness Assessments
Psychological Assessments
Quality and Safety in Neurosurgery
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