Institution-Based Quality and Safety Improvement Initiatives in Spine Surgery: A Scoping Review

Improving patient safety and healthcare quality is necessary to advance value-based health care. Spine surgery is complex, entailing joint efforts between different disciplines. This scoping review aimed to map the research on establishing and implementing institution-based quality improvement (QI) initiatives in spine surgery.

Studies were identified in electronic searches of PubMed, Web of Science, and Scopus databases. Qualitative or quantitative studies that report the implementation of QI programs that occurred in or covered spine surgery were included; studies that did not describe the establishment, implementations, impacts, barriers, and facilitators of QI initiatives were excluded. Three reviewers independently screened the retrieved studies, and 2 reviewers extracted data and conducted a quality assessment of full-text articles. Studies were categorized according to dimensions of quality (timely, effective, patient-centered, efficient, equitable, and safe), and quality appraisal was conducted using the Standards for Quality Improvement Reporting Excellence reporting guidelines.

The search from the 3 databases yielded 2,876 returns; after removing duplicates, there were 1,274 in total. After screening, 228 records were entered into a full-text review, resulting in 133 records included in the review. Specifically, 88 addressed aspects of efficiency, 74 on safety, 32 on improving effectiveness, 23 on patient-centeredness, 7 on timeliness, and 1 on equity. Of the studies included, 71 rely on retrospective audits, 19 are prospective, and only 8 are interventional trials. Only 67 QI initiatives leveraged the advantages of multidisciplinary teams or the rigor of evidence-based protocols. Study gaps include limited follow-up, small sample sizes, and lack of comprehensive assessment using both objective measures and patient-reported outcomes.

This scoping review maps the current research on developing and implementing institution-based QI initiatives in spine surgery. Although most of the initiatives reported show improvement in the quality of health care and patient safety from multiple aspects, the sustainability of these initiatives remains unknown, and further studies are needed to trace the long-term effects and generalizability of these initiatives.