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Neurosurgery Putting Patient Safety First

kris med stGuest post written on behalf of

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

Kristopher T. Kimmell, MD (right)
Neurosurgical Resident,
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 “” 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 at the University of California, San Francisco, made patient safety the theme of the 81st AANS Annual Scientific Meeting and included it as a key focus of his .

psIn 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 (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 , with the input of the and the AANS/CNS joint Sections, worked with the (ACGME) to incorporate them into the 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 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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One Comment

  • Wayel Kaakaji says:

    The Patient Safety Committee of the CSNS has been growing rapidly due to keen interest among neurosurgeons in promoting safety in our patient population. Neurosurgery is a field of very high acuity patients, with complex procedural therapies, and therefor demands a sharp focus on adverse events, their genesis, and their avoidance.

    We should never lose focus, however, of the safety breaches that lurk among our most mundane tasks. We must re-examine our processes for sign out/handovers, review of test results, and our communications with other providers, extenders, office staff, hospital agents, etc. Teamwork in surgical teams is a skill that requires constant refining as we deal with an ever more complex sociotechnical work environment.

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