Mapping the Clinical Pathway for Patients Undergoing Vestibular Schwannoma Resection

Background and Objectives: Vestibular schwannomas (VS) can be managed through surveillance, surgery or radiation therapy. Optimal management for VS requires input from neurosurgeons, otorhinolaryngologists, nurse specialists, and therapy teams. Given the low volume caseload, the clinical data collected for VS patients can be a scarce commodity. The introduction of electronic health records (EHR) has improved the collection and storage of patient information, enhancing communication and academia. However, EHRs remain limited by data quality and manual data extraction. To address these challenges, structured data entry and automated data collection tools can be used to capture clinical information and extract valuable data, respectively, reducing human error and maintaining quality. To aid in the successful implementation of structured data entry and automated data collection, this study aims to utilize process mapping to identify critical data entry points within the VS resection clinical pathway, to help improve patient care and research.

Methods: A two-stage mixed methodology was conducted at a single neurosurgical unit. Process maps were created using semi-structured interviews with key stakeholders within the skull base multidisciplinary team. Subsequently, process maps were then retrospectively validated against EHR for patients admitted between August 2019 and December 2021. Critical data points were identified based on the presence or absence of clinical events within each patient’s medical notes (even if only present once). Critical data points were then grouped by frequency (100%, 90–99%, 80–89%, and <80%).

Results: Twenty stakeholders were interviewed in the process map development. Process maps were validated against the EHR of 36 patients admitted for VS resection. Operation notes, surgical inpatient reviews (including ward rounds), and discharge summaries were present for all patients, representing critical data entry points. Areas for documentation improvement were present in the preoperative clinics (30/36, 83.3%), preoperative skull base multidisciplinary team (32/36, 88.9%), postoperative follow-up clinics (32/36, 88.9%), and the postoperative skull base multidisciplinary team meeting (29/36, 80.6%).

Conclusion: This is the first use of a two-stage mixed methodology for process mapping the clinical pathway for VS resection. Our study has identified critical data entry points suitable for structured data entry and automated data collection, positively impacting patient care. Next steps will include the production of a core dataset of variables related to VS patients, followed by structured data entry templates and behavioral interventions to prompt adherence to data entry practices ([Figs. 1] [2] [3] [4]).

Fig. 1: Process map development.

Fig. 2 Process map from presentation to health care services through to operation. Solid lines represent pathways must occur and dashed lines represent multiple options. Color codes indicate % of presence of documentation in real-world cohort data.

Fig. 3 Process map from operation through to discharge from hospital. Solid lines represent pathways must occur and dashed lines represent multiple options. Color codes indicate % of presence of documentation in real-world cohort data.

Fig. 4 Process map depicting the outpatient pathways following vestibular schwannoma resection. Solid lines represent pathways must occur and dashed lines represent multiple options. Color codes indicate % of presence of documentation in real-world cohort data.

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Artikel online veröffentlicht:
07. Februar 2025