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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.
Insights
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.
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.
Objective:
To improve quality of care for patients presenting with chronic subdural haematoma (CSDH) by introducing a multi-disciplinary integrated care pathway.
Summary Background:
CSDH is a common neurological condition. Incidence rises with age and currently affects around 58/100 000 people over 70 years. Six-month mortality is high (26%), however integrated care pathways have been shown to improve patient outcomes in other surgical subspecialties.
Materials And Methods:
A baseline retrospective audit completed in 2012 identified areas for improvement in patient management. Stakeholder meetings were held with subsequent development and implementation of a patient care pathway. A post-implementation prospective audit was completed between January and October 2015.
Data Collected:
patient demographics, medical co-morbidities, use of anti-platelet and anti-coagulant medication, timing of surgery, length of hospital stay, morbidity and mortality data, and reaccumulation rate.
Results:
Patient groups were similar with a high incidence of multi-morbidity. The key areas targeted for improvement included enhanced pre-operative optimisation and time to surgery. Implementation of the patient care pathway significantly increased the number of patients undergoing surgery within 24 hours of admission (43% vs. 75%, p = 0.0006) but length of hospital stay did not change. Operative morbidity and mortality remained similar and there was no significant difference in CSDH reaccumulation rate.
Conclusion:
Our patient care pathway appears to have improved pre-operative care and significantly increased the proportion of patients undergoing surgery within 24 hours of admission. Difficulties were encountered with changing existing practice. Prospective research is required to demonstrate the full benefits, which may include a reduction in health and social care costs.
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