Quality Improvement in Neurocritical Care: a Review of the Current Landscape and Best Practices

Abstract

Purpose of Review The field of neurocritical care (NCC) has grown such that there is now a substantial body of literature on quality improvement specific to NCC. This review will discuss the development of this literature over time and highlight current best practices with practical tips for providers. Recent Findings There is tremendous variability in patient care models for NCC patients, despite evidence showing that certain structural elements are associated with better outcomes. There now also exist evidence-based recommendations for neurocritical care unit (NCCU) structure and processes, as well as NCC-specific performance measure (PM) sets; however, awareness of these is variable among care providers. The evidence-based literature on NCC structure, staffing, training, standardized order sets and bundles, transitions of care including handoff, prevention of bounce backs, bed flow optimization, and inter-hospital transfers is growing and offers many examples of successful performance improvement initiatives in NCCUs. Summary NCC providers care for patients with life-threatening conditions like intracerebral and subarachnoid hemorrhages, ischemic stroke, and traumatic brain injury, which are associated with high morbidity, complexity of treatment, and cost. Quality improvement initiatives have been successful in improving many aspects of NCC patient care, and NCC providers should continue to update and standardize their practices with consideration of this data. More research is needed to continue to identify high-risk and high-cost NCCU structures and processes and strategies to optimize them, validate current NCC PMs, and encourage clinical adoption of those that prove to be associated with improved outcomes.

Clinical Experience With a Dedicated Neurocritical Care Quality Improvement Program in an Academic Medical Center

“…Strong institutional backing also plays a pivotal role in driving sustainable change by enabling the development and implementation of evidence-based interventions, providing opportunities for ongoing education and training, and fostering collaboration among healthcare providers. In summary, departmental and hospital support is essential for the success of an NCC-QIP [ 36 ], as it creates an environment conducive to continuous learning, improvement, and the pursuit of excellence in patient care. The success of the NCC-QIP is bolstered by the support of the Department of Anesthesiology and Pain Medicine, which provides resources, guidance, and oversight for the program.…”

Technical report: clinical feasibility of augmented reality-navigated chronic subdural hematoma evacuation

“…EVD placement, ICP monitor placement, subdural drain placement, SEPS drain placement, etc. ), emergency craniotomies and decompressive craniectomies, and ventricular shunt procedures are not performed with image guidance due to long setup times, cost, lack of availability, and/or cumbersome nature of the technology which may outweigh the benefit of image guidance [ 12 ]. Technological alternatives which provide enhanced visualization without the limitations of traditional navigation systems are needed.…”

Semiology of the neurocritical patient: understanding the language of neurological signs

“…In the intensive care setting, most of the time, the clinical condition of the patient makes it impossible to obtain as detailed anamnesis as desired, which is why family members are a fundamental part of this first step of the clinical history since they are the ones who will provide the most data on the onset of symptoms, whether these were sudden or gradual, associated with particular clinical situations (weight loss, behavioral or behavioral changes, fever, seizures, sensory or motor disturbances, and among others) 4 . When obtaining medical history, gathering comprehensive details regarding any prior medical conditions, the treatments received, and the approach taken to manage them is crucial.…”

“…It is also important to evaluate the fluency of spoken language and speech coherence as they may be altered in patients with delirium, bipolar disorders (manic phase), and disorganized thinking. The speed of speech and the number of ideas that are expressed evaluate not only the language but also the speed of thought so that tachylalia and flight of opinions can give a picture of the degree of mental compromise in the patient 1,2,4 .…”