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Benjamin J. Kuo, Joao Ricardo N. Vissoci, Joseph R. Egger, Emily R. Smith, Gerald A. Grant, Michael M. Haglund and Henry E. Rice

P ediatric neurosurgery has one of the highest morbidity rates among pediatric surgical subspecialties. 15 As health care costs rise, focus has increased on improving surgical outcomes through quality improvement (QI) initiatives. Advancements in the use of large risk-adjusted national databases allow for better delineation of relationships between patient risk factors and quality measures, such as postoperative adverse events (AEs). Understanding these correlations can support targeted QI programs as well as enhance clinical management. The American

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Colin C. Buchanan, Estebes A. Hernandez, Jody M. Anderson, Justin A. Dye, Michelle Leung, Farzad Buxey, Marvin Bergsneider, Nasim Afsar-Manesh, Nader Pouratian and Neil A. Martin

/quaternary neurosurgical service, we studied 30-day readmissions to the Department of Neurosurgery at two of the University of California, Los Angeles (UCLA), Health System hospitals after index admission over a 3-year period. Such analyses are critical for defining the problem so that the area to target for quality improvement within neurosurgery can be identified. Methods Using administrative data for May 2009 through May 2012, we retrospectively identified adult and pediatric patients who had undergone a major neurosurgical procedure at UCLA Ronald Reagan Medical Center or UCLA

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Judith M. Wong, Allen L. Ho, Ning Lin, Georgios A. Zenonos, Christopher B. Martel, Kai Frerichs, Rose Du and William B. Gormley

correction factor would be consistent across all estimated radiation doses received per patient. Although it is clear that the information garnered from radiographic studies guides management decisions, we believe it is possible to reduce the amount of imaging and its consequent radiation exposure without compromising decision-making capacity. For example, Loftus et al. 21 showed that the implementation of a simple algorithm for practice quality improvement reduced cumulative radiation exposure by 12% in aneurysmal SAH patients. At our institution, we have designed and

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Sheila L. Ryan, Anish Sen, Kristen Staggers, Thomas G. Luerssen and Andrew Jea

approaches. Recent work in other areas of medicine and surgery has demonstrated beneficial results from quality improvement methodology. 13 This methodology involves the development and implementation of standardized, incremental protocols for common health care processes to decrease unexplained clinical variation, measurement of compliance, and observation of the effect on outcome. 13 The Hydrocephalus Clinical Research Network (HCRN) in pediatric neurosurgery demonstrated a decreased CSF shunt infection rate from 8.8% prior to application of a standardized protocol

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Marlina E. Lovett, Melissa Moore-Clingenpeel, Onsy Ayad and Nicole O’Brien

has been associated with a prolonged intensive care unit (ICU) length of stay, poor neurological outcome, and an increased risk of TBI-related mortality. 3 , 5 , 8 , 11 , 13 In addition, studies have shown that a reduction of hyperthermia to normothermia can reduce cerebral oxygen demand in the nonshivering patient. 7 In an effort to decrease hyperthermia burden in our pediatric ICU (PICU), we implemented a quality improvement initiative targeting the maintenance of normothermia for the first 72 hours of admission following severe TBI. We hypothesized that, if a

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Virendra R. Desai, Jeffrey S. Raskin, Arvind Mohan, JoWinsyl Montojo, Valentina Briceño, Daniel J. Curry and Sandi Lam

. This high rate of infection was confirmed to be above national benchmarks. This information motivated a quality improvement initiative that included the development and implementation of an infection prevention bundle with evidence-based best practice. We examined the postoperative infection and postoperative complication outcomes before and after implementation of the protocol. Methods Bundle Creation We designed an intervention for quality improvement using a Plan-Do-Study-Act (PDSA) model. 26 The interventions in this protocol were chosen based on a literature

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John R. W. Kestle, Jay Riva-Cambrin, John C. Wellons III, Abhaya V. Kulkarni, William E. Whitehead, Marion L. Walker, W. Jerry Oakes, James M. Drake, Thomas G. Luerssen, Tamara D. Simon and Richard Holubkov

. Typical hospitalizations last 7–21 days. 9 Despite these measures, recurrent infection is common. 9 , 10 Clearly, prevention of infection is essential, and many techniques have been promoted to minimize the risk. Recent work in other areas of medicine and surgery has demonstrated beneficial results using quality improvement methodology. This methodology involves the development and application of standardized, stepwise protocols for common health care processes, measurement of compliance, and observation of the effect on outcome. Single-center studies using these

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Nancy McLaughlin, Peng Jin and Neil A. Martin

assessing reoperations. Reported rates have varied widely (0.6% to 9.4%) depending on the definition, method of detection, case selection criteria, heterogeneity of practices, and difference in department and hospital practices. 4 , 9 , 20 Therefore, the appropriateness of the “absolute” rate of reoperations as a quality indicator enabling quality improvement and comparison between departments and organizations has been questioned. To date, studies reporting department-wide reoperation rates are scarce in neurosurgery. 18 , 21 As departments aim to deliver optimal

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Nancy McLaughlin, Matthew C. Garrett, Leila Emami, Sarah K. Foss, Johanna L. Klohn and Neil A. Martin

liability has been provided from national or state survey results or data from medical insurance companies. 5 , 13 , 18 We present a review of liability claims/suits within a tertiary academic neurosurgical department. A detailed review of claim/suit standardized abstracts and comprehensive understanding of contributing factors is reported. Identified opportunities for improvement are integrated in the department’s quality improvement initiatives to improve global care delivered. From this unique perspective, departmental engagement is essential to inspire all health

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Ariane Lewis, Aaron Rothstein and Donato Pacione

system while CSF is collected. 26 , 27 Patients with lumbar drains at the authors’ institution previously were given PPSA and had CSF sampled daily. In the past few years, the Neurosurgical Quality Improvement Committee instituted changes to the lumbar drain management protocol, and at present, antibiotics are only given and CSF is only sampled at the time of drain placement or if there is suspicion for infection. In the present analysis, the effects of these quality improvement initiatives were retrospectively evaluated by reviewing the frequency of SSI, CDI, and