Thomas N J, Mertens P, Danaila T, Polo G, Klinger H, Broussolle E, Thobois S
Department of Integrated Health Solutions, Medtronic Trading International Sàrl Europe, Tolochenaz, Switzerland.
Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Neurochirurgie A, Bron, France.
J Neurol. 2017 Jul;264(7):1454-1464. doi: 10.1007/s00415-017-8548-2. Epub 2017 Jun 19.
Management of Parkinson's disease (PD) using deep brain stimulation (DBS) requires complex care in specialized, multidisciplinary centers. A well-organized, efficient patient flow is crucial to ensure that eligible patients can quickly access DBS. Delays or inefficiencies in patient care may impact a center's ability to meet demand, creating a capacity bottleneck. Analysis of the current practices within a center may help identify areas for improvement. After external audit of the DBS workflow of the Lyon Neurological Hospital and comparison with other European centers, manageable steps were suggested to restructure the care pathway. Propositions of the audit comprised, for example: (1) directly admitting referred patients to hospital, without a prior neurological outpatient visit and (2) including the preoperative anesthesia consultation in the hospital stay 1 month before surgery, not separately. This reorganization (between 2013 and 2016) was performed without increases in hospital medical resources or costs. The time from patients' first referral to surgery was reduced (from 22 to 16 months; p = 0.033), as was the number of pre- and postoperative patient visits (11-5; p = 0.025) and the total cumulative length of in-hospital stay (20.5-17.5 nights; p = 0.02). Ultimately, the total number of PD consultations increased (346-498 per year), as did the number of DBS implants per year (32-45 patients). In this single center experience, restructuring the DBS care pathway allowed a higher number of PD patients to benefit from DBS therapy, with a shorter waiting time and without decreasing the quality of care.
使用脑深部电刺激（DBS）治疗帕金森病（PD）需要在专业的多学科中心提供复杂的护理。组织良好、高效的患者流程对于确保符合条件的患者能够快速接受DBS治疗至关重要。患者护理中的延误或效率低下可能会影响中心满足需求的能力，从而造成能力瓶颈。分析中心内的当前做法可能有助于确定改进领域。在对里昂神经医院的DBS工作流程进行外部审计并与其他欧洲中心进行比较后，提出了一些可管理的步骤来重组护理路径。审计建议包括，例如：（1）直接将转诊患者收治入院，无需事先进行神经科门诊就诊；（2）将术前麻醉会诊纳入手术前1个月的住院期间，而不是单独进行。这种重组（在2013年至2016年期间）在没有增加医院医疗资源或成本的情况下进行。从患者首次转诊到手术的时间缩短了（从22个月降至16个月；p = 0.033），术前和术后患者就诊次数也减少了（从11次降至5次；p = 0.025），住院总累计时长也缩短了（从20.5晚降至17.5晚；p = 0.02）。最终，PD会诊的总数增加了（从每年346次增至498次），每年DBS植入手术的数量也增加了（从32例患者增至45例患者）。在这个单中心经验中，重组DBS护理路径使更多的PD患者能够受益于DBS治疗，等待时间更短，且不降低护理质量。
