Pilot Program to Improve Transfer of Care Between Neurosurgical and Outpatient Neurology Teams Following Implantation of an Intrathecal Baclofen Pump

Abstract

PILOT PROGRAM TO IMPROVE TRANSFER OF CARE BETWEEN NEUROSURGICAL AND OUTPATIENT NEUROLOGY TEAMS FOLLOWING IMPLANTATION OF AN INTRATHECAL BACLOFEN PUMP

Erika Mitchell, M.S.N.

Thesis Advisor: Maureen Moriarty, DNP

ABSTRACT

Current clinic procedure in a large urban hospital-based outpatient Neurology practice does not include standardized handoff communications for ITBP patients during transfer or transition of care, specifically between Neurosurgery and Neurology. The paucity of interdisciplinary communication leads to lengthy durations of time between pump implantation and outpatient follow-up, poor continuity of care, and increased potential for avoidable negative events.

A new pilot workflow was developed by the researcher and implemented over a 24 week time frame. Comparison data were obtained via EMR from the same time cycle of the previous year. Metrics evaluated included average days to Neurology clinic follow-up post implantation, frequency of pre-surgical notification, and frequency of post-surgical handoff between Neurosurgical and Neurology team members. Neurology and Neurosurgical team members were asked to complete a pre/post implementation electronic survey to assess changes in perception of teamwork.

Average days to Neurology follow-up post implantation decreased 31.5 days during the pilot study. This was found to be statistically significant with a p-value of 0.03. The incidence of pre-surgical notification to outpatient Neurology increased from 0% to 83.3%. The incidence of post-surgical handoff report increased from 0% to 50%. The average teamwork survey scores showed an insignificant change from a mean of 4.59 to 4.62.

The pilot study aimed to implement a standardized communication workflow in an effort to decrease days to follow-up post-op, increase frequency of patient presurgical notification, increase frequency of post implantation handoff report, and evaluate for change provider interdisciplinary teamwork. Although the data did indicate a decrease in days to follow-up, improved communication and handoff frequency, the pilot workflow is not sustainable. Unanticipated culture barriers and provider time restrictions proved detrimental to the success and feasibility of the project. Changes to the workflow, including collaboration with the Medtronic ITBP representatives and pre-procedure scheduling of outpatient Neurology follow-up appointments could offer realistic and viable alternatives to achieve communication goals.