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Related Experiment Video

Updated: Mar 6, 2026

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
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Chronic subdural haematomas: a single-centre experience developing an integrated care pathway.

Smita Bapat1, Jonathan Shapey2, Ahmed Toma2

  • 1a Department of Neuroanaesthesia , National Hospital for Neurology and Neurosurgery , London , UK.

British Journal of Neurosurgery
|March 8, 2017
PubMed
Summary

A new integrated care pathway for chronic subdural haematoma (CSDH) significantly improved pre-operative care and timely surgery. While CSDH outcomes remained similar, the pathway enhanced patient management for this common neurological condition.

Keywords:
Chronic subdural haematomaelderlyintregrated care pathwaymultidisciplinaryoptimisationpreoperative

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Area of Science:

  • Neurosurgery
  • Geriatric Medicine
  • Healthcare Management

Background:

  • Chronic subdural haematoma (CSDH) is a prevalent neurological condition, particularly in the elderly, with high mortality rates.
  • Existing integrated care pathways have demonstrated success in improving patient outcomes in other surgical fields.
  • A baseline audit identified critical areas for improvement in CSDH patient management.

Purpose of the Study:

  • To enhance the quality of care for patients with chronic subdural haematoma (CSDH).
  • To implement and evaluate a multi-disciplinary integrated care pathway for CSDH management.
  • To improve pre-operative optimization and reduce time to surgery for CSDH patients.

Main Methods:

  • A retrospective audit was conducted in 2012 to identify areas for improvement.
  • A multi-disciplinary patient care pathway was developed and implemented following stakeholder engagement.
  • A prospective audit from January to October 2015 collected data on patient demographics, comorbidities, medications, surgical timing, and outcomes.

Main Results:

  • The integrated care pathway significantly increased the proportion of patients undergoing surgery within 24 hours of admission (43% to 75%).
  • No significant changes were observed in length of hospital stay, operative morbidity, mortality, or CSDH reaccumulation rates.
  • Patient groups were comparable, with a high incidence of multi-morbidity in both baseline and post-implementation cohorts.

Conclusions:

  • The implemented care pathway successfully improved pre-operative care and expedited surgical intervention for CSDH.
  • Challenges were encountered in modifying established clinical practices.
  • Further prospective research is needed to fully ascertain the benefits, including potential reductions in healthcare costs.