Improving Compliance with a Novel Pre-Operative Assessment Pathway for Neurosurgical Referrals.

The clinical presentation of neurosurgical patients tends to be sporadic in nature. These patients present to healthcare settings across the country before being referred to the National Referral Centre for Neurosurgery and Neurology in Ireland. The growing demands on the healthcare sector, such as an ageing population and finite resources, has limited the luxury of in-patient pre-operative assessment days prior to surgery. The organisation in question had established a nurse-led pre-operative assessment clinic for elective neurosurgical referrals. This pre-assessment clinic improved the day of surgery admission rate by almost 50%. An additional cohort of neurosurgical patient referrals were identified, which are neither surgically elective nor emergency, but deemed ‘urgent.’ These are predominantly patients with newly diagnosed brain tumours. In October 2019, the Neurosurgery Outreach Pre-Operative Assessment Service (NeurO-PAS) was established at this organisation to pre-assess urgent brain tumour referrals from the referring hospital – prior to inter-hospital transfer. This quality improvement (QI) project aims to improve compliance with the NeurO-PAS pathway, therefore, reducing the investigation duplication rate. The Lean Six Sigma QI model was utilised to develop this project, under guidance of the DMAIC framework. QI tools, such as, stakeholder analysis, process flow maps and a fishbone diagram, were compiled to identify the root cause of duplicated investigations. Analysis of collected data portrays that duplications are associated with a lack of pathway awareness and communication breakdown. Improved compliance with the pathway could potentially reduce the rate of investigations duplicated, thus, improving the patient flow to neurosurgery.