Challenges and patient outcomes in chronic subdural haematoma at the level of a regional care system A multi-centre, mixed-methods study from the East of England.

Autor:	Stubbs DJ; Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK., Khanna S; Department of Perioperative, Acute, Critical, and Emergency Care (PACE), University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK., Davies BM; Department of Clinical Neurosurgery, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK., Vivian ME; Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK., Bashford T; Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.; Department of Engineering, Health Systems Design Group, Trumpington Street, Cambridge CB2 1PZ, UK., Adatia K; Department of Anaesthesia, North West Anglia Foundation Trust, Peterborough City Hospital, Peterborough PE3 9GZ, UK., Chen P; Department of Anaesthesia, Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust, Gayton Road, Kings Lynn, PE30 4ET, UK., Clarkson PJ; Department of Engineering, Health Systems Design Group, Trumpington Street, Cambridge CB2 1PZ, UK., McGlennan C; Department of Anaesthesia, Bedfordshire Hospital NHS Foundation Trust, Luton and Dunstable University Hspital, Lewsey Road, Luton, LU4 ODZ, UK., Indurawage L; Department of Anaesthesia, James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth NR31 6LA, UK., Patel M; Older People's Medicine Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, UK.; Clinical Associate Professor in Translational and Clinical Medicine, Norwich Medical School, University of East Anglia, Norwich, UK., Tyagunenko R; Department of Anaesthesia, Northwest Anglia NHS Foundation Trust, Hinchingbrooke Hospital, Parkway Hinchingbrooke, Huntingdon PE29 6NT, UK., Burnstein R; Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK., Menon DK; Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK., Hutchinson PJ; Department of Clinical Neurosurgery, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK., Joannides A; Department of Clinical Neurosurgery, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
Jazyk:	angličtina
Zdroj:	Age and ageing [Age Ageing] 2024 Apr 01; Vol. 53 (4).
DOI:	10.1093/ageing/afae076
Abstrakt:	Background: Chronic subdural haematoma (cSDH) is a common neurosurgical pathology affecting older patients with other health conditions. A significant proportion (up-to 90%) of referrals for surgery in neurosciences units (NSU) come from secondary care. However, the organisation of this care and the experience of patients repatriated to non-specialist centres are currently unclear. Objectives: This study aimed to clarify patient outcome in non-specialist centres following NSU discharge for cSDH surgery and to understand key system challenges. The study was set within a representative neurosurgical care system in the east of England. Design and Methods: We performed a retrospective cohort analysis of patients referred for cSDH surgery. Alongside case record review, patient and staff experience were explored using surveys as well as an interactive c-design workshop. Challenges were identified from thematic analysis of survey responses and triangulated by focussed workshop discussions. Results: Data on 381 patients referred for cSDH surgery from six centres was reviewed. One hundred and fifty-six (41%) patients were repatriated following surgery. Sixty-one (39%) of those repatriated suffered an inpatient complication (new infection, troponin rise or renal injury) following NSU discharge, with 58 requiring institutional discharge or new care. Surveys for staff (n = 42) and patients (n = 209) identified that resourcing, communication, and inter-hospital distance posed care challenges. This was corroborated through workshop discussions with stakeholders from two institutions. Conclusions: A significant amount of perioperative care for cSDH is delivered outside of specialist centres. Future improvement initiatives must recognise the system-wide nature of delivery and the challenges such an arrangement presents. (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.)
Databáze:	MEDLINE
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