1University of Miami Miller School of Medicine, Miami; and.
Departments of2Neurosurgery.
Neurosurg Focus. 2021 Nov;51(5):E4. doi: 10.3171/2021.8.FOCUS21378.
Timely ventriculostomy placement is critical in the management of neurosurgical emergencies. Prompt external ventricular drain (EVD) placement has been shown to improve long-term patient outcomes and decrease the length of ICU and hospital stays. Successful and efficient EVD placement requires seamless coordination among multiple healthcare teams. In this study, the authors sought to identify factors favoring delayed ventriculostomy via a quality improvement initiative and to implement changes to expedite EVD placement.
Through process mapping, root cause analysis, and interviews with staff, the authors identified the lack of a standardized mechanism for alerting necessary healthcare teams as a major contributor to delays in EVD placement. In December 2019, an EVD alert system was developed to automatically initiate an EVD placement protocol and to alert the neurosurgery department, pharmacy, core laboratory, and nursing staff to prepare for EVD placement. The time to EVD placement was tracked prospectively using time stamps in the electronic medical record.
A total of 20 patients who underwent EVD placement between December 2019 and April 2021, during the EVD alert protocol initiation, and 18 preprotocol control patients (January 2018 to December 2019) met study inclusion criteria and were included in the analysis. The mean time to EVD placement in the control group was 71.88 minutes compared with 50.3 minutes in the EVD alert group (two-tailed t-test, p = 0.025). The median time to EVD placement was 64 minutes in the control group compared with 52 minutes in the EVD alert group (rank-sum test, p = 0.0184). All patients from each cohort exhibited behavior typical of stable processes, with no violation of Shewhart rules and no special cause variations on statistical process control charts.
A quality improvement framework helped identify sources of delays to EVD placement in the emergency department. An automated EVD alert system was a simple intervention that significantly reduced the time to EVD placement in the emergency department and can be easily implemented at other institutions to improve patient care.
在神经外科急症的处理中，及时进行脑室造口术至关重要。及时进行外部脑室引流（EVD）放置已被证明可以改善长期患者预后，并缩短 ICU 和住院时间。成功和高效的 EVD 放置需要多个医疗团队之间的无缝协调。在这项研究中，作者试图通过质量改进计划确定导致脑室造口术延迟的因素，并实施改变以加快 EVD 放置。
通过流程映射、根本原因分析和与员工的访谈，作者发现缺乏一种标准化的机制来提醒必要的医疗团队是导致 EVD 放置延迟的主要原因。2019 年 12 月，开发了一种 EVD 警报系统，以自动启动 EVD 放置方案，并提醒神经外科、药房、核心实验室和护理人员准备进行 EVD 放置。通过电子病历中的时间戳，前瞻性地跟踪 EVD 放置的时间。
共有 20 名患者在 2019 年 12 月至 2021 年 4 月期间接受了 EVD 放置，在此期间启动了 EVD 警报协议，18 名对照患者（2018 年 1 月至 2019 年 12 月）符合研究纳入标准并纳入分析。对照组的平均 EVD 放置时间为 71.88 分钟，而 EVD 警报组为 50.3 分钟（双侧 t 检验，p = 0.025）。对照组的 EVD 放置中位数时间为 64 分钟，而 EVD 警报组为 52 分钟（秩和检验，p = 0.0184）。每个队列的所有患者都表现出稳定过程的典型行为，没有违反谢哈特规则，也没有特殊原因在统计过程控制图上发生变化。
质量改进框架有助于确定急诊室 EVD 放置延迟的原因。自动 EVD 警报系统是一种简单的干预措施，可显著缩短急诊室 EVD 放置时间，其他机构也可轻松实施，以改善患者护理。
