Optimizing the deep brain stimulation care pathway in patients with Parkinson's disease
| Autor: | Hélène Klinger, Emmanuel Broussolle, N. J. Thomas, Stéphane Thobois, Gustavo Polo, T. Danaila, Patrick Mertens |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Deep brain stimulation Neurology Parkinson's disease Time Factors Referral medicine.medical_treatment Deep Brain Stimulation Audit Disease Single Center 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine Neuroradiology Clinical Audit business.industry Parkinson Disease medicine.disease Emergency medicine Physical therapy Critical Pathways Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Journal of neurology. 264(7) |
| ISSN: | 1432-1459 |
| Popis: | Management of Parkinson’s disease (PD) using deep brain stimulation (DBS) requires complex care in specialized, multidisciplinary centers. A well-organized, efficient patient flow is crucial to ensure that eligible patients can quickly access DBS. Delays or inefficiencies in patient care may impact a center’s ability to meet demand, creating a capacity bottleneck. Analysis of the current practices within a center may help identify areas for improvement. After external audit of the DBS workflow of the Lyon Neurological Hospital and comparison with other European centers, manageable steps were suggested to restructure the care pathway. Propositions of the audit comprised, for example: (1) directly admitting referred patients to hospital, without a prior neurological outpatient visit and (2) including the preoperative anesthesia consultation in the hospital stay 1 month before surgery, not separately. This reorganization (between 2013 and 2016) was performed without increases in hospital medical resources or costs. The time from patients’ first referral to surgery was reduced (from 22 to 16 months; p = 0.033), as was the number of pre- and postoperative patient visits (11–5; p = 0.025) and the total cumulative length of in-hospital stay (20.5–17.5 nights; p = 0.02). Ultimately, the total number of PD consultations increased (346–498 per year), as did the number of DBS implants per year (32–45 patients). In this single center experience, restructuring the DBS care pathway allowed a higher number of PD patients to benefit from DBS therapy, with a shorter waiting time and without decreasing the quality of care. |
| Databáze: | OpenAIRE |
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