Assessing the cost of contemporary pituitary care.

Object: Knowledge of the costs incurred through the delivery of neurosurgical care has been lagging, making it challenging to design impactful cost-containment initiatives. In this report, the authors describe a detailed cost analysis for pituitary surgery episodes of care and demonstrate the importance of such analyses in helping to identify high-impact cost activities and drive value-based care.

Methods: This was a retrospective study of consecutively treated patients undergoing an endoscopic endonasal procedure for the resection of a pituitary adenoma after implementation and maturation of quality-improvement initiatives and the implementation of cost-containment initiatives.

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery.

Object: Care providers have put significant effort into optimizing patient safety and quality of care. Value, defined as meaningful outcomes achieved per dollar spent, is emerging as a promising framework to redesign health care. Scarce data exist regarding cost measurement and containment for episodes of neurosurgical care.

Analysis of 30-day readmissions among neurosurgical patients: surgical complication avoidance as key to quality improvement.

Unlabelled: OBJECT.: In terms of measuring quality of care and hospital performance, an outcome of increasing interest is the 30-day readmission rate. Recent health care policy making has highlighted the necessity of understanding the factors that influence readmission.

Tracking and sustaining improvement initiatives: leveraging quality dashboards to lead change in a neurosurgical department.

Increasingly, hospitals and physicians are becoming acquainted with business intelligence strategies and tools to improve quality of care. In 2007, the University of California Los Angeles (UCLA) Department of Neurosurgery created a quality dashboard to help manage process measures and outcomes and ultimately to enhance clinical performance and patient care. At that time, the dashboard was in a platform that required data to be entered manually.

Value-based neurosurgery: the example of microvascular decompression surgery.

Object: Value of care is emerging as a promising framework to restructure health care, emphasizing the importance of reporting multiple outcomes that encompass the entire care episode instead of isolated outcomes specific to care points during a patient's care. The authors assessed the impact of coordinated implementation of processes across the episode of surgical care on value of neurosurgical care, using microvascular decompression (MVD) as an example.

Methods: This study is a retrospective review of consecutive cases involving patients with either trigeminal neuralgia or hemifacial spasm undergoing first-time MVD.

Subclinical early posttraumatic seizures detected by continuous EEG monitoring in a consecutive pediatric cohort.

Purpose: Traumatic brain injury (TBI) is an important cause of morbidity and mortality in children, and early posttraumatic seizures (EPTS) are a contributing factor to ongoing acute damage. Continuous video-EEG monitoring (cEEG) was utilized to assess the burden of clinical and electrographic EPTS.

Methods: Eighty-seven consecutive, unselected (mild - severe), acute TBI patients requiring pediatric intensive care unit (PICU) admission at two academic centers were monitored prospectively with cEEG per established clinical TBI protocols.

A comparison of vital signs charted by nurses with automated acquired values using waveform quality indices.

Objective: (1) To investigate if there exist any discrepancies between the values of vital signs charted by nurses and those recorded by bedside monitors for a group of patients admitted for neurocritical care. (2) To investigate possible interpretations of discrepancies by exploring information in the alarm messages and the raw waveform data from monitors.

Methods: Each charted vital sign value was paired with a corresponding value from data collected by an archival program of bedside monitors such that the automatically archived data preceded the charted data and had minimal time lag to the charted value.

Intensive care unit robotic telepresence facilitates rapid physician response to unstable patients and decreased cost in neurointensive care.

Background: The timely assessment and treatment of ICU patients is important for neurosurgeons and neurointensivists. We hypothesized that the use of RTP can improve physician rapid response to unstable ICU patients.

Methods: This is a prospective study using a before-after, cohort-control design to test the effectiveness of RTP.