In search of the perfect outcome in neuroanaesthesia and neurocritical care

Flexman, Alana M.; Tung, Alan

doi:10.1111/anae.15637

Cited by 3 publications

(4 citation statements)

References 34 publications

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“…This assesses changes in a patient's level of functionality in discrete domains including: level of consciousness; independence with activities of daily living; ability to work and participate in social and leisure activities; psychological impacts on relationships; and return to normal life (Table 3). However, there are limitations to the GOS-E, most importantly that it may not fully represent the patient's assessment of their own quality of life [63].I n addition, most trials limit the assessment of GOS-E to 6 months after injury, even though neurological recovery can improve or deteriorate over subsequent years. A recent study assessed GOS-E at four time-points in 484 patients who suffered moderate to severe TBI (Table 3) [64].…”

Section: Prognosticationmentioning

confidence: 99%

Management of traumatic brain injury in the non‐neurosurgical intensive care unit: a narrative review of current evidence

et al. 2023

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Each year, approximately 70 million people suffer traumatic brain injury, which has a significant physical, psychosocial and economic impact for patients and their families. It is recommended in the UK that all patients with traumatic brain injury and a Glasgow coma scale ≤ 8 should be transferred to a neurosurgical centre. However, many patients, especially those in whom neurosurgery is not required, are not treated in, nor transferred to, a neurosurgical centre. This review aims to provide clinicians who work in non-neurosurgical centres with a summary of contemporary studies relevant to the critical care management of patients with traumatic brain injury. A targeted literature review was undertaken that included guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials (published in English between 1 January 2017 and 1 July 2022). Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also eligible for inclusion. Analysis of the topics identified during the review was then summarised. These included: fundamental critical care management approaches (including ventilation strategies, fluid management, seizure control and osmotherapy); use of processed electroencephalogram monitoring; non-invasive assessment of intracranial pressure; prognostication; and rehabilitation techniques. Through this process, we have formulated practical recommendations to guide clinical practice in non-specialist centres.

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Section: Prognosticationmentioning

confidence: 99%

Management of traumatic brain injury in the non‐neurosurgical intensive care unit: a narrative review of current evidence

et al. 2023

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“…First, anesthesiology commonly lacks validated, robust, consensus-driven indicators of success to demonstrate the role of anesthesiologists in creating value 1. Given the unique features of patients with neurological disease, further work is required to identify optimal perioperative outcomes for this cohort 30. Although surrogate metrics are often collected (eg, preoperative antibiotic administration), they typically focus on process compliance, are rarely patient-centered, and do not directly measure outcomes.…”

Section: Future Research and Challenges To Value-based Care In Periop...mentioning

confidence: 99%

“…1 Given the unique features of patients with neurological disease, further work is required to identify optimal perioperative outcomes for this cohort. 30 Although surrogate metrics are often collected (eg, preoperative antibiotic administration), they typically focus on process compliance, are rarely patient-centered, and do not directly measure outcomes. Some neuroanesthesiologists may view their role as having limited impact on patients' functional A further frequent barrier to health care transformation is a lack of robust infrastructure and resources to measure and report patient-centered outcomes and inform system improvement, particularly given the overworked and exhausted health care workforce.…”

Section: Future Research and Challenges To Value-based Care In Periop...mentioning

confidence: 99%

Value-based Care and Quality Improvement in Perioperative Neuroscience

Luoma

Flexman

2022

Journal of Neurosurgical Anesthesiology

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Value-based care and quality improvement are related concepts used to measure and improve clinical care. Value-based care represents the relationship between the incremental gain in outcome for patients and cost efficiency. It is achieved by identifying outcomes that are important to patients, codesigning solutions using multidisciplinary teams, measuring both outcomes and costs to drive further improvements, and developing partnerships across the health system. Quality improvement is focused on process improvement and compliance with best practice, and often uses "Plan-Do-Study-Act" cycles to identify, test, and implement change. Validated, standardized core outcome sets for perioperative neuroscience are currently lacking, but neuroanesthesiologists can consider using traditional clinical indicators, patient-reported outcomes measures, and perioperative core outcome measures. Several examples of bundled care solutions have been successfully implemented in perioperative neuroscience to increase value; for example, enhanced recovery for spine surgery, delirium reduction pathways, and same-day discharge craniotomy. This review proposes potential individualand system-based solutions to address barriers to value-based care and quality improvement in perioperative neuroscience.

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“…There is increasing recognition that there should be a shift towards patient‐reported outcome measures (e.g. patient‐reported outcomes measurement information system (PROMIS)) that assess aspects such as meaningful functional recovery and quality of life for both the patient and their family [18]. A core outcome set of standardised outcome measures for research involving the management of CSDH is currently under development in partnership between healthcare professionals, patients and carers [19].…”

Section: Surgery In the Real Worldmentioning

confidence: 99%