Neurosurgery Putting Patient Safety First

Guest post written on behalf of The CSNS Patient Safety Ad Hoc Committee

Abdul-Kareem Ahmed (left)
Medical Student at Brown University
Providence, Rhode Island

Kristopher T. Kimmell, MD (right)
Neurosurgical Resident, University of Rochester Medical Center
Rochester, NY

Since neurosurgical pioneer Harvey Cushing invented the modern anesthesia record and helped lower the morbidity and mortality of all operations then and since, neurosurgeons have been intensely interested in patient safety. Contemporary reports have estimated that thousands of people experience preventable hospital errors, highlighting patient safety as an important public policy topic. The full dimensions of this issue were brought to light initially in the Institute of Medicine (IOM) Report “To Err is Human” in 1999.

Although research on preventable errors in neurosurgery is limited, neurosurgeons across the country and organized neurosurgery are leading efforts to improve patient safety. In fact, AANS past president, Mitchel S. Berger, MD, FAANS, chair of the department of neurosurgery at the University of California, San Francisco, made patient safety the theme of the 81^st AANS Annual Scientific Meeting and included it as a key focus of his presidential address.

In response to the need for organized neurosurgery to cultivate a culture of patient safety, the Council of State Neurosurgical Societies (CSNS) Immediate Past-Chair Mark E. Linskey, MD, FAANS, formed the Ad Hoc Committee for Patient Safety (AHCPS) in 2013, coinciding with Dr. Berger’s focus on the issue. Over the past two years, the ACHPS has developed a wide range of educational programs including:

• Patient safety principles;
• The use of checklists;
• Informing patients of their rights and responsibilities;
• Improving communication within the neurosurgical team;
• Using information technology; and
• Avoiding wrong-level surgery.

Teamwork and communication are particularly important concepts for patient safety. To ensure these principles are also imparted to future neurosurgeons, the Residency Review Committee for Neurological Surgery, with the input of the Society of Neurological Surgeons and the AANS/CNS joint Sections, worked with the Accreditation Council of Graduate Medical Education (ACGME) to incorporate them into the Neurological Surgery Milestones Project in 2013. These milestones define neurosurgical competency beyond simply duty hours and surgical cases and incorporate quality improvement into neurosurgical training. These efforts acknowledge that strong leadership, mutual respect, and frequent feedback sessions allow for improved outcomes.

Patient safety and high quality care are being prioritized and measured across all medical and surgical specialties, and neurosurgery is adapting accordingly. This self-assessment and improvement process is a key aspect of the ACGME’s Next Accreditation System (NAS). Patient safety is also a key component of many pay-for-performance models being implemented by healthcare stakeholders.

Leaders within neurosurgery have recognized the need for improvement and are identifying new pathways for process improvement. As these new initiatives are incorporated into practice, above all, the tenet to prioritize patient safety is Primum non Nocere, “First do no harm.”

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