Quality Spine Care by John Ratliff & Todd J. Albert & Joseph Cheng & Jack Knightly

Author:John Ratliff & Todd J. Albert & Joseph Cheng & Jack Knightly
Language: eng
Format: epub
ISBN: 9783319979908
Publisher: Springer International Publishing

British Spine Registry (BSR) Pathways

Lumbar degenerative

Cervical and thoracic degenerative

Tumour

Trauma

Infection

Deformity

Intra-dural

Once the disease-specific pathway was defined, relevant details of the presenting clinical symptoms and signs, information on co-morbidities and other conditions were agreed to define the patient-level pathology being treated. Design of the database aimed to capture reliable, reproducible details of the presenting complaint whilst allowing risk stratification of the subsequent results.

Arguably the most important part of any surgical register is the information defining the procedure performed. For each Pathway, the procedure form collects an ‘operative log’ detailing Surgeon, Hospital, Payer and a series of conditional questions defining the surgical procedure, approach, levels, implants and intraoperative complications. A comprehensive search tool was created to enable rapid lookup of the implants available in the UK market for the specific procedure in question, with a view to long-term implant surveillance.

As recognised previously, the success or failure of a CQR is largely based on the routine capture of large volumes of reliable data on a set of procedures. Initially, the BSR had no mandatory data set as there was concern this would affect uptake. Mandatory fields have now been introduced to ensure standard collection of these items which will be essential for future analysis. The principle of a mandatory data field is that the surgeon must know the answer at the end of surgery without having to measure or search for the information. Most of the mandated data points relate to patient demographics, basic presenting symptomatology, risk stratification information (e.g. co-morbidities) and surgical details. The surgical procedure is broken down into groupings to aid later comparison. In this regard, a procedure to release a nerve would be coded as decompression with or without discectomy. The details of the specific decompression performed can be easily recorded by tabulation, with an example of a central and lateral recess decompression at L4/5 demonstrated in Fig. 11.6. This enables reliable and reproducible recording of the levels and types of surgery without lengthy notation or the risk of typographical error. Single or multi-select boxes are preferred to drop down lists to reduce the number of mouse clicks and make it easier to use on a touchscreen device.

Fig. 11.6BSR screenshot of level selection tabulation by push button

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