1Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla.
2Hospital-at-Home Department, Hospital Universitario Marqués de Valdecilla.
Neurosurg Focus. 2022 Jun;52(6):E8. doi: 10.3171/2022.3.FOCUS2242.
Despite growing evidence on the benefits of outpatient oncological neurosurgery (OON), it is only performed in a few specialized centers and there are no previous descriptions of established OON programs in Europe. Moreover, increasing application of telemedicine strategies, especially after the start of the coronavirus disease 2019 (COVID-19) pandemic, is drastically changing neurosurgical management, particularly in the case of vulnerable populations such as neuro-oncological patients. In this context, the authors implemented an OON program in their hospital with telematic follow-up. Herein, they describe the protocol and qualitatively analyze the barriers and facilitators of the development process.
An OON program was developed through the following steps: assessment of hospital needs, specific OON training, multidisciplinary team organization, and OON protocol design. In addition, the implementation phase included training sessions, a pilot study, and continuous improvement sessions. Finally, barriers and facilitators of the protocol's implementation were identified from the feedback of all participants.
An OON protocol was successfully designed and implemented for resection or biopsy of supratentorial lesions up to 3 cm in diameter. The protocol included the patient's admission to the day surgery unit, noninvasive anesthetic monitoring, same-day discharge, and admission to the hospital-at-home (HaH) unit for telematic and on-site postoperative care. After a pilot study including 10 procedures in 9 patients, the main barriers identified were healthcare provider resistance to change, lack of experience in outpatient neurosurgery, patient reluctance, and limitations in the recruitment of patients. Key facilitators of the process were the patient education program, the multidisciplinary team approach, and the HaH-based telematic postoperative care.
Initiating an OON program with telematic follow-up in a European clinical setting is feasible. Nevertheless, it poses several barriers that can be overcome by identifying and maximizing key facilitators of the process. Among them, patient education, a multidisciplinary team approach, and HaH-based postoperative care were crucial to the success of the program. Future studies should investigate the cost-effectiveness of telemedicine to assess potential cost savings, from reduced travel and wait times, and the impact on patient satisfaction.
尽管越来越多的证据表明门诊肿瘤神经外科学（OON）的益处，但它仅在少数几个专业中心进行，并且以前没有关于欧洲既定 OON 计划的描述。此外，尤其是在冠状病毒病 2019（COVID-19）大流行开始后，远程医疗策略的应用不断增加，正在极大地改变神经外科的管理，尤其是在神经肿瘤患者等弱势群体的情况下。在这种情况下，作者在他们的医院实施了一个带有远程医疗随访的 OON 计划。在此，他们描述了该方案，并从发展过程中的障碍和促进因素方面进行了定性分析。
通过以下步骤制定了 OON 计划：评估医院需求、特定的 OON 培训、多学科团队组织以及 OON 方案设计。此外，实施阶段包括培训课程、试点研究和持续改进课程。最后，从所有参与者的反馈中确定了方案实施的障碍和促进因素。
成功设计并实施了一项用于切除或活检直径达 3 厘米的幕上病变的 OON 方案。该方案包括患者入住日间手术病房、非侵入性麻醉监测、当天出院以及入住医院-家庭（HaH）病房进行远程和现场术后护理。在包括 9 名患者的 10 例手术的试点研究之后，确定的主要障碍是医疗保健提供者对变革的抵制、缺乏门诊神经外科经验、患者的不情愿以及患者招募方面的限制。该过程的关键促进因素是患者教育计划、多学科团队方法以及基于 HaH 的远程术后护理。
在欧洲临床环境中，通过远程医疗随访启动 OON 计划是可行的。然而，它带来了一些障碍，这些障碍可以通过识别和最大化过程中的关键促进因素来克服。其中，患者教育、多学科团队方法和基于 HaH 的术后护理对该计划的成功至关重要。未来的研究应该调查远程医疗的成本效益，以评估潜在的节省成本，包括减少旅行和等待时间以及对患者满意度的影响。
