Integrated care pathways in neurosurgery: A systematic review

Abstract

Introduction Integrated care pathways (ICPs) are a pre-defined framework of evidence based, multidisciplinary practice for specific patients. They have the potential to enhance continuity of care, patient safety, patient satisfaction, efficiency gains, teamwork and staff education. In order to inform the development of neurosurgical ICPs in the future, we performed a systematic review to aggregate examples of neurosurgical ICP, to consider their impact and design features that may be associated with their success. Methods Electronic databases MEDLINE, EMBASE, and CENTRAL were searched for relevant literature published from date of inception to July 2020. Primary studies reporting details of neurosurgical ICPs, across all pathologies and age groups were eligible for inclusion. Patient outcomes in each case were also recorded. Results Twenty-four studies were included in our final dataset, from the United States, United Kingdom, Italy, China, Korea, France, Netherlands and Switzerland, and a number of sub-specialties. 3 for cerebrospinal fluid diversion, 1 functional, 2 neurovascular, 1 neuro-oncology, 2 paediatric, 2 skull base, 10 spine, 1 for trauma, 2 miscellaneous (other craniotomies). All were single centre studies with no regional or national examples. Thirteen were cohort studies while 11 were case series which lacked a control group. Effectiveness was typically evaluated using hospital or professional performance metrics, such as length of stay (n = 11, 45.8%) or adverse events (n = 17, 70.8%) including readmission, surgical complications and mortality. Patient reported outcomes, including satisfaction, were evaluated infrequently (n = 3, 12.5%). All studies reported a positive impact. No study reported how the design of the ICP was informed by published literature or other methods Conclusions ICPs have been successfully developed across numerous neurosurgical sub-specialities. However, there is often a lack of clarity over their design and weaknesses in their evaluation, including an underrepresentation of the patient’s perspective.

Are We Considering the Whole Patient? The Impact of Physical and Mental Health on the Outcomes of Spine Care

“…Another alternative path forward is the integration of multidisciplinary care-including mental health resources-directly into spine programs. Multiple studies have demonstrated the positive effects of these programs on the outcomes of patients suffering from both operatively and nonoperatively managed spine conditions, [41][42][43][44] although further study of their impact on mental health specifically is needed.…”

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

“…A Cochrane review defined five criteria for a clinical pathway to include an organized multidisciplinary plan of care, translation of guidelines to current practice, provides specific steps in a course of care, gives a timeframe, and aims to standardize care for a specific population, problem, or procedure (Youngerman et al, 2019). Implementing a clinical pathway can benefit DBS patients by ensuring they receive interventions in a timely and efficient manner, reducing practice differences, decreasing readmissions, and improving the length of stay and patient satisfaction (Lee et al, 2021). These aforementioned studies show that clinical pathways or ERAS vary greatly across medical institutions.…”

“…A systematic review of neurosurgery care pathways returns twenty-four clinical pathways with only one functional neurosurgery pathway (Lee et al, 2021). This systematic review shows a lag in functional clinical pathways but may not be all inclusive of the literature given the inclusion criteria used.…”

“…Pathways enhance continuity of care and patient satisfaction while also improving efficiency, teamwork, staff education, and reducing variation in practice (Lee et al, 2021). Many studies have evaluated neurosurgery ERAS pathways for elective surgeries, including craniotomies.…”

“…Pathways are viewed as a roadmap for patient care, relying on multidisciplinary involvement and utilization of a variety of health care specialties often showing positive results (Lee et al, 2021). A Cochrane review defined five criteria for a clinical pathway to include an organized multidisciplinary plan of care, translation of guidelines to current practice, provides specific steps in a course of care, gives a timeframe, and aims to standardize care for a specific population, problem, or procedure (Youngerman et al, 2019).…”