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'Possible shunt malfunction' pathway for paediatric hydrocephalus-a study of clinical outcomes and cost implications
Liting Tong1, Louise Higgins2, Gnanamurthy Sivakumar2
1Department of Neurosurgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK. liting.tong@nhs.net.
Insights
The shunt malfunction pathway for pediatric hydrocephalus patients showed only 16% required surgery, demonstrating its efficiency. This pathway reduces unnecessary interventions and healthcare costs associated with shunt complications.
Area of Science:
- Pediatric Neurosurgery
- Medical Auditing
- Healthcare Management
Background:
- Shunt insertion for hydrocephalus is a common pediatric neurosurgery.
- Shunt complications are frequent, with high failure rates within the first year.
- An open-door 'possible shunt malfunction' pathway facilitates rapid assessment for children with shunts.
Purpose of the Study:
- To audit the clinical outcomes and costs of the 'possible shunt malfunction' pathway.
- To assess the percentage of confirmed shunt dysfunction and patient re-attendances.
- To evaluate the financial impact of the pathway on healthcare.
Main Methods:
- Prospective data collection over 7 months for patients in the triage service.
- Recording attendances, previous shunt revisions, shunt type, and investigations (CT, X-rays).
- Obtaining cost data for physician, inpatient stay, and investigations from hospital procurement.
Main Results:
- 81 attendances by 62 patients were recorded; only 16% resulted in surgical management.
- Approximately 17% of patients re-attended the service at least once.
- The average cost per attendance was £765.57, with inpatient stays comprising 49.2% of total costs.
Conclusions:
- The 'possible shunt malfunction' pathway effectively identified children needing intervention, with only 16% requiring neurosurgery.
- Investigations for potential shunt blockage incur significant health, social, and financial costs.
- High rates of shunt failure, re-attendance, and investigations create a substantial financial burden on the healthcare system.
Background:
Shunt insertion for hydrocephalus is a common paediatric neurosurgery procedure. Shunt complications are frequent with an estimated 20-40% failure rate within the first year, and 4.5% per year subsequently. We have an open-door 'possible shunt malfunction' pathway for children treated with a shunt or endoscopic third ventriculostomy, providing direct ward access to ensure rapid assessment and timely management of children.
Objective:
To audit the 'possible shunt malfunction' pathway in terms of clinical outcomes (percentage-confirmed shunt dysfunction and number of re-attendances) and costs.
Methods:
Clinical data for patients attending the triage service were prospectively recorded over 7 months-including the number of attendances, previous shunt revisions, shunt type, investigations performed (CT, x-rays), and outcome. Costings (e.g. costs of physician, inpatient stay, investigations) were obtained from the hospital's procurement department.
Results:
In the study period, there were 81 attendances by 62 patients and only 16% of attendances resulted in surgical management (either shunt revision or ETV). Approximately 17% of patients re-attended at least once. The average cost per attendance in our pathway was £765.57 ($969.63; €858.73). The total expenditure for the pathway over 7 months was £62,011.03 ($78,540.07; €69,556.81), with inpatient stay making up the biggest percentage of cost (49.2%).
Conclusion:
Only 16% (13 attendances) of those attending through our pathway required neurosurgical intervention. Investigations for possible blocked shunt come at significant health, social, and financial cost. High rates of shunt failure, re-attendance, investigations, and inpatient stays incur a sizable financial burden to the healthcare system.
