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Greenwood JC, Gutierrez K, McDermott M. Results of a Pilot Study for a Pharmacy Discharge Review in Neurosurgical Patients: A Quality-Safety Initiative. Cureus 2023; 15:e36067. [PMID: 37056529 PMCID: PMC10092899 DOI: 10.7759/cureus.36067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2023] [Indexed: 03/18/2023] Open
Abstract
Objective A multidisciplinary collaboration between the neurosurgical team and the pharmacy was established to conduct a pilot study in which discharged neurosurgical patients from a community hospital would receive medication reconciliation services and counseling by a pharmacy specialist to determine the impact on patient safety, readmission rates, and medication compliance. Methods Pharmacists reviewed discharge medication reconciliations of neurosurgical patients to address any discrepancies with the nurse practitioners or physicians prior to discharge and provided discharge medication counseling to the patient/families at the bedside. The service was provided on weekdays during the eight-hour pharmacist shift in addition to other daily responsibilities. Data were analyzed by type and the total number of pharmacy interventions encountered during the discharge medication reconciliation process, time to complete services, and readmission rates. Lastly, the discharged neurosurgical patients that were not seen by pharmacists during the one-month pilot study were reviewed retrospectively to determine potential interventions. Results A total of 48 neurosurgical patients were discharged during the one-month pilot study; 27 patients received discharge medication reconciliation services and counseling from the pharmacy specialists. Sixty-three pharmacy interventions were accepted with prevention of medication errors/adverse drug reactions (21%, n=21) and addition of missing medication (21%, n=21) being the most common intervention types. The mean time to complete the services was 27 minutes and there was one non-medication-related readmission of the 27 patients seen. Twenty-one neurosurgical patients who were discharged without receiving services were reviewed retrospectively. It was determined that there was a potential for another 64 pharmacy interventions in which clarification of indication (33%, n=21) was the most common intervention type, followed by prevention of medication errors/adverse drug reactions (25%, n=16) and addition of missing medication (22%, n=14). There was a total of one medication-related readmission of the 21 patients not seen by the pharmacist during the pilot study. Conclusion The collaboration of pharmacists in the discharge process benefits neurosurgical patients by reducing the number of discrepancies when transitioning home and provides an additional layer of safety to reduce medication errors and/or prevent adverse events.
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Iihara K, Saito N, Suzuki M, Date I, Fujii Y, Houkin K, Inoue T, Iwama T, Kawamata T, Kim P, Kinouchi H, Kishima H, Kohmura E, Kurisu K, Maruyama K, Matsumaru Y, Mikuni N, Miyamoto S, Morita A, Nakase H, Narita Y, Nishikawa R, Nozaki K, Ogasawara K, Ohata K, Sakai N, Sakamoto H, Shiokawa Y, Takahashi JC, Ueki K, Wakabayashi T, Yoshimoto K, Arai H, Tominaga T. The Japan Neurosurgical Database: Statistics Update 2018 and 2019. Neurol Med Chir (Tokyo) 2021; 61:675-710. [PMID: 34732592 PMCID: PMC8666296 DOI: 10.2176/nmc.st.2021-0254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Each year, the Japan Neurosurgical Society (JNS) reports up-to-date statistics from the Japan Neurosurgical Database regarding case volume, patient demographics, and in-hospital outcomes of the overall cohort and neurosurgical subgroup according to the major classifications of main diagnosis. We hereby report patient demographics, in-hospital mortality, length of hospital stay, purpose of admission, number of medical management, direct surgery, endovascular treatment, and radiosurgery of the patients based on the major classifications and/or main diagnosis registered in 2018 and 2019 in the overall cohort (523283 and 571143 patients, respectively) and neurosurgical subgroup (177184 and 191595 patients, respectively). The patient demographics, disease severity, proportion of purpose of admission (e.g., operation, 33.9-33.5%) and emergent admission (68.4-67.8%), and in-hospital mortality (e.g., cerebrovascular diseases, 6.3-6.5%; brain tumor, 3.1-3%; and neurotrauma, 4.3%) in the overall cohort were comparable between 2018 and 2019. In total, 207783 and 225217 neurosurgical procedures were performed in the neurosurgical subgroup in 2018 and 2019, respectively, of which endovascular treatment comprised 19.1% and 20.3%, respectively. Neurosurgical management of chronic subdural hematoma (19.4-18.9%) and cerebral aneurysm (15.4-14.8%) was most common. Notably, the proportion of management of ischemic stroke/transient ischemic attack, including recombinant tissue plasminogen activator infusion and endovascular acute reperfusion therapy, increased from 7.5% in 2018 to 8.8% in 2019. The JNS statistical update represents a critical resource for the lay public, policy makers, media professionals, neurosurgeons, healthcare administrators, researchers, health advocates, and others seeking the best available data on neurosurgical practice.
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Affiliation(s)
- Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | | | - Michiyasu Suzuki
- Department of Advanced ThermoNeuroBiology, Yamaguchi University Graduate School of Medicine
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University School of Medicine
| | - Toru Iwama
- Department of Neurosurgery, Gifu University School of Medicine
| | | | - Phyo Kim
- Department of Neurologic Surgery, Utsunomiya Neurospine Center
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, University of Yamanashi Interdisciplinary Graduate School of Medicine
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Eiji Kohmura
- Kinki Central Hospital of the Mutual Aid Association of Public School Teachers
| | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital
| | - Keisuke Maruyama
- Department of Neurosurgery, Kyorin University, School of Medicine
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | | | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
| | | | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science
| | | | | | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Hiroaki Sakamoto
- Department of Pediatric Neurosurgery, Osaka City General Hospital
| | | | - Jun C Takahashi
- Department of Neurosurgery, Kindai University Faculty of Medicine
| | - Keisuke Ueki
- Department of Neurologic Surgery, Dokkyo Medical University
| | | | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | | | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
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Chiu RG, Fuentes AM, Patil SN, Chiu R, McGuire LS, Mehta AI. Cannabis Abuse and Perioperative Complications After Treatment of Intracranial Aneurysms: A Nationwide Analysis. World Neurosurg 2021; 158:e184-e195. [PMID: 34757211 DOI: 10.1016/j.wneu.2021.10.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In the present retrospective cohort analysis, we examined the differences in baseline characteristics and peri- and postoperative outcomes stratified by 3 groups: cannabis abuse or dependence versus none, surgical versus endovascular treatment, and unruptured and ruptured intracranial aneurysms. METHODS A study population of 26,868 patients was defined using the 2009-2016 National Inpatient Sample database. The baseline characteristics were compared between the cannabis and no-cannabis groups, and the traits that differed significantly were factored into the multivariate analysis using 1:1 propensity score matching. The matched groups were analyzed to compare the cannabis and no-cannabis cohorts for the following endpoints: mortality, length of stay, discharge disposition, total hospital charges, and several peri- and postoperative outcomes. RESULTS In the surgically and endovascularly treated groups for unruptured intracranial aneurysms, those in the cannabis group were more likely to be male and younger and to smoke tobacco than were those in the no-cannabis group. After matching, no significant endpoint differences were noted. Similarly, in the surgically and endovascularly treated ruptured aneurysm groups, those in the cannabis group were more likely to be male and younger and to smoke tobacco. After matching, the cannabis group within the endovascular treatment group had had a longer length of stay and were more likely to have developed any hydrocephalus, obstructive hydrocephalus, sepsis, and acute kidney injury. Those in the cannabis group who had undergone surgery were more likely to have developed any hydrocephalus, specifically, communicating hydrocephalus. CONCLUSIONS The cannabis group with ruptured intracranial aneurysms was more likely to experience certain adverse outcomes after surgical or endovascular treatment compared with the no-cannabis group. However, such was not the case for cannabis abusers treated for unruptured aneurysms.
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Affiliation(s)
- Ryan G Chiu
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shashank N Patil
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Richard Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Laura S McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Acevedo-Aguilar L, Lozada-Martínez I, Gaitan-Herrera G, Bohorquez-Caballero A, Moscote-Salazar L, Al-Dhahir MA. Letter to the Editor Regarding "Characteristics and Burden of Diagnostic Error-Related Malpractice Claims in Neurosurgery". World Neurosurg 2021; 147:252. [PMID: 33685025 DOI: 10.1016/j.wneu.2020.12.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ivan Lozada-Martínez
- Medical-Surgical Research Center, University of Cartagena, Cartagena, Colombia; Latin American Council of Neurocritical Care (CLaNi), Cartagena, Colombia; Colombian Clinical Research Group in Neurocritical Care, University of Cartagena, Cartagena de Indias, Colombia; Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia.
| | | | | | - Luis Moscote-Salazar
- Medical-Surgical Research Center, University of Cartagena, Cartagena, Colombia; Latin American Council of Neurocritical Care (CLaNi), Cartagena, Colombia; Colombian Clinical Research Group in Neurocritical Care, University of Cartagena, Cartagena de Indias, Colombia
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Boyke AE, Bader ER, Naidu I, Lam S, Alvi MA, Funari A, Agarwal V. Medical malpractice and meningiomas: an analysis of 47 cases. Neurosurg Focus 2020; 49:E22. [DOI: 10.3171/2020.8.focus20598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEAmong medical practices, surgical fields, including neurosurgery, are at a high risk for medical malpractice litigation. With meningiomas contributing to 10% of the total neurosurgery litigation cases, the aim of this study was to identify demographic characteristics, reasons for litigation, and surgical complications commonly reported in these cases. This analysis serves to increase neurosurgeons’ awareness of factors associated with medical malpractice litigation.METHODSThe online legal database Westlaw was utilized to query public litigation cases related to the medical management of meningiomas between December 1985 and May 2020. Variables extracted included the following: plaintiff and defendant demographics, litigation category, plaintiff medical complaints, and trial outcomes. The authors compared these characteristics between cases with decisions in favor of the defendant and those with decisions in favor of the plaintiff.RESULTSA total of 47 cases met the inclusion criteria. Failure to diagnose (68.1%) was the most common type of malpractice claim, and surgical complications (19.1%), motor weakness (33%), and financial loss (33%) were cited as the most common postoperative complaints. Individual specialties that most often required defense due to malpractice claims were radiology (21.7%) and neurosurgery (19.6%). The jury verdict was in favor of the defense in 51.1% of cases and in favor of the plaintiff in 27.7% of cases. A settlement was reached in 19.1% of cases. The mean payout for a verdict in favor of the plaintiff was $3,409,650.22, while the mean payout for settlements was $867,555.56. The greatest average payout for specialties was in neurosurgery at $3,414,400, followed by radiology at $3,192,960. Cases with a verdict in favor of the plaintiff were more likely to involve an internal medicine physician as a defendant (p = 0.007).CONCLUSIONSOver one-half of the cases resulted in a defendant’s verdict with failure to diagnose cited as the most common reason for litigation. Radiology and neurosurgery were the most common specialties for legal cases and also had some of the largest average payouts based on specialty. Motor weakness and financial loss were the most common plaintiff postoperative complaints. These findings may inform surgeons on active measures to take, such as increasing focus on diagnostic accuracy and reducing specific postoperative complaints, such as motor weakness, through risk management and prophylactic measures, to reduce unfavorable legal outcomes.
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Affiliation(s)
- Andre E. Boyke
- 1Department of Neurological Surgery, Montefiore Medical Center, New York
| | - Edward R. Bader
- 2Department of Neurological Surgery, Albert Einstein College of Medicine, New York, New York; and
| | - Ishan Naidu
- 1Department of Neurological Surgery, Montefiore Medical Center, New York
| | - Sharon Lam
- 1Department of Neurological Surgery, Montefiore Medical Center, New York
| | - Mohammed Ali Alvi
- 3Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Abigail Funari
- 1Department of Neurological Surgery, Montefiore Medical Center, New York
| | - Vijay Agarwal
- 1Department of Neurological Surgery, Montefiore Medical Center, New York
- 2Department of Neurological Surgery, Albert Einstein College of Medicine, New York, New York; and
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Lopez Ramos C, Rennert RC, Brandel MG, Abraham P, Hirshman BR, Steinberg JA, Santiago-Dieppa DR, Wali AR, Porras K, Almosa Y, Pannell JS, Khalessi AA. The effect of hospital safety-net burden on outcomes, cost, and reportable quality metrics after emergent clipping and coiling of ruptured cerebral aneurysms. J Neurosurg 2020; 132:788-796. [PMID: 30797220 DOI: 10.3171/2018.10.jns18103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 10/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Safety-net hospitals deliver care to a substantial share of vulnerable patient populations and are disproportionately impacted by hospital payment reform policies. Complex elective procedures performed at safety-net facilities are associated with worse outcomes and higher costs. The effects of hospital safety-net burden on highly specialized, emergent, and resource-intensive conditions are poorly understood. The authors examined the effects of hospital safety-net burden on outcomes and costs after emergent neurosurgical intervention for ruptured cerebral aneurysms. METHODS The authors conducted a retrospective analysis of the Nationwide Inpatient Sample (NIS) from 2002 to 2011. Patients ≥ 18 years old who underwent emergent surgical clipping and endovascular coiling for aneurysmal subarachnoid hemorrhage (SAH) were included. Safety-net burden was defined as the proportion of Medicaid and uninsured patients treated at each hospital included in the NIS database. Hospitals that performed clipping and coiling were stratified as low-burden (LBH), medium-burden (MBH), and high-burden (HBH) hospitals. RESULTS A total of 34,647 patients with ruptured cerebral aneurysms underwent clipping and 23,687 underwent coiling. Compared to LBHs, HBHs were more likely to treat black, Hispanic, Medicaid, and uninsured patients (p < 0.001). HBHs were also more likely to be associated with teaching hospitals (p < 0.001). No significant differences were observed among the burden groups in the severity of subarachnoid hemorrhage. After adjusting for patient demographics and hospital characteristics, treatment at an HBH did not predict in-hospital mortality, poor outcome, length of stay, costs, or likelihood of a hospital-acquired condition. CONCLUSIONS Despite their financial burden, safety-net hospitals provide equitable care after surgical clipping and endovascular coiling for ruptured cerebral aneurysms and do not incur higher hospital costs. Safety-net hospitals may have the capacity to provide equitable surgical care for highly specialized emergent neurosurgical conditions.
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Lopez Ramos C, Williams JE, Bababekov YJ, Chang DC, Carter BS, Jones PS. Assessing the Understandability and Actionability of Online Neurosurgical Patient Education Materials. World Neurosurg 2019; 130:e588-e597. [DOI: 10.1016/j.wneu.2019.06.166] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 02/06/2023]
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Lopez Ramos C, Brandel MG, Rennert RC, Wali AR, Steinberg JA, Santiago-Dieppa DR, Burton BN, Pannell JS, Olson SE, Khalessi AA. Clinical Risk Factors and Postoperative Complications Associated with Unplanned Hospital Readmissions After Cranial Neurosurgery. World Neurosurg 2018; 119:e294-e300. [DOI: 10.1016/j.wneu.2018.07.136] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 12/18/2022]
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The Effect of July Admission on Inpatient Morbidity, Mortality, and Discharge Disposition After Endovascular Coiling in Subarachnoid Hemorrhage. World Neurosurg 2018; 109:e170-e174. [DOI: 10.1016/j.wneu.2017.09.126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/19/2017] [Indexed: 12/20/2022]
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