Implementation of a Deep Brain Stimulation Perioperative Pathway for Patients with Medically Refractory Neurological Movement Disorders

Abstract

This project aims to evaluate the outcomes of patients with medically refractory movement disorders treated with deep brain stimulation (DBS) following implementation of a standardized care pathway. Aims included decreasing length of stay (LOS), improving cost efficiency, reducing unintended 30-day readmission rates, and optimizing overall patient care.Methods: A quality improvement project was conducted at a single, large academic medical center located in the southeastern United States and focused on adult patients (>18yrs) with Parkinson's disease, essential tremor, or dystonia undergoing initial DBS implantation. A multidisciplinary team was developed and a value stream mapping (VSM) analysis of the DBS process was performed to identify areas of unnecessary cost, inefficiency, and potential improvement. An evidence-based DBS clinical pathway was developed and implemented into practice including updating patient education materials, perioperative order sets, anesthesia protocols and a patient satisfaction survey. Pre-implementation (N=150) and postimplementation (N=29) cohorts were statistically compared for differences in LOS, readmission rates and cost, during stage 2 (electrode implantation) of the DBS process.Results: A significant predictor of increased LOS was living in a rural county (p=0.010).Increased cost was associated with age >65 (p<0.0001), primary diagnosis essential tremor (p=0.050), and ethnicity (p=0.004). Readmission rates are higher in patients with >2 baseline medical comorbidities (p<0.001) and males have a significantly shorter interval to readmission than women (p=0.013).