Neurosurgery Resident Mayo Clinic Rochester, Minnesota, United States
Introduction: Quality improvement (QI) has a long, established track record in neurosurgery dating back to the early influences of Harvey Cushing. Over the years, there has been a plethora of QI initiatives aimed at improving patient outcomes, streamlining hospital processes, and enhancing professional development in spine care. These projects have ranged substantially in scope; however, no prior studies have synthesized or analyzed this broad body of work in a systematic fashion. As such, the purpose of this study was to perform a systematic review and analysis of the QI literature in spine care.
Methods: A systematic literature review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations. A search algorithm was employed using the Medline database from its inception to August 2022. Articles were included if they were (1) QI projects with an aim that included (2) patients with spine pathologies.
Results: The literature review identified 725 studies. A total of 438 database/registry reviews, 179 non-QI research projects, and 25 non-spine articles were excluded via title/abstract review. Eighty-three studies were screened; 8 retrospective studies or reviews, 2 non-QI, 1 non-spine, and 1 duplicate were excluded when assessing manuscripts for eligibility. Seventy-one projects were included in the final analysis: 20 pathway, 17 pediatrics, 9 imaging, 7 narcotics, 7 trauma/fracture, 6 Enhanced Recovery After Surgery (ERAS), and 5 infection projects. Most were conducted in the United States and were completed in 1-2 years. The number of active QI projects has steadily increased since 1995. Most were led either by orthopedic surgeons or neurosurgeons, followed by anesthesiologists. However, many did not have any authors affiliated with a neurosurgery department. Seventeen different QI methods were used, including Lean, Six Sigma and Plan Design Study Act (PDSA) cycles. Few adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines for medical QI research.
Conclusion : We report the first PRISMA-compliant systematic review of QI projects in clinical spine. While QI is becoming increasingly popular over time, we recommend that healthcare professionals use the SQUIRE guidelines to design effective QI projects.
