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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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Katrina Ducis, R. Dianne Seibold, Tylyn Bremer, and Andrew Jea

, including coagulopathy, impaired immune function, suboptimal wound healing capacity, 6 decreased clearance of anesthetic agents, 7 and prolonged hospitalization, 8 thereby increasing healthcare costs. Patients undergoing spine surgery were observed by an operating room nurse to have marked decreased core body temperatures prior to surgery onset. This led to the institution of a nurse-driven quality improvement initiative with the goal of reducing the severity and duration of hypothermia, as defined by a temperature less than 36.0°C prior to the start of the operation

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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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Albert M. Isaacs, Chad G. Ball, Nicholas Sader, Sandeep Muram, David Ben-Israel, Geberth Urbaneja, Jarred Dronyk, Richard Holubkov, and Mark G. Hamilton

–related infections have primarily been performed in the pediatric population. 16 , 17 To our knowledge, there has been no study in adults that simultaneously addresses all three key elements. This underscores the need to challenge current surgical approaches to VP shunt surgery by evaluating combined modifications to surgical methodology that have demonstrated promising results when undertaken in isolation. A quality improvement (QI) methodology provides an excellent platform to undertake this type of inquiry. 18 , 19 Evidence compelling enough to convince neurosurgeons to alter

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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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Jason Chu, Hailey Jensen, Richard Holubkov, Mark D. Krieger, Abhaya V. Kulkarni, Jay Riva-Cambrin, Curtis J. Rozzelle, David D. Limbrick Jr., John C. Wellons III, Samuel R. Browd, William E. Whitehead, Ian F. Pollack, Tamara D. Simon, Mandeep S. Tamber, Jason S. Hauptman, Jonathan Pindrik, Robert P. Naftel, Patrick J. McDonald, Todd C. Hankinson, Eric M. Jackson, Brandon G. Rocque, Ron Reeder, James M. Drake, John R. W. Kestle, and

P ediatric CSF shunt infection remains a common complication and carries significant patient morbidity. Additionally, treatment for shunt infections is costly, with estimates as high as $50,000 per occurrence. 1 The Hydrocephalus Clinical Research Network (HCRN) has adopted quality improvement (QI) initiatives and implemented standardized surgical protocols to reduce shunt infection. We first reported our 11-step protocol in 2011 (protocol 1; Fig. 1 ) and successfully reduced network-wide shunt infection from 8.8% to 5.7%. 2 Our second report simplified