GME Patient Safety Quality and Innovation Symposium

Background: Patients with acute neurological illness requiring hospitalization have a specific set of inpatient needs that are distinct from those who are admitted for primary medical or surgical indications. Many of these needs can be addressed on initial admission with specific orders. Currently, the inpatient general neurology team uses the “acute care non-ICU admission” order set for all admissions onto the service that is an order set that is available to all UCSD services. However, this admission order set is not tailored to meet the specific needs of a patient population that is ill with an acute neurological disorder requiring hospitalization.

Description: Earlier in this academic year, an M&M conference was held by the clinical service chair, inpatient neurology faculty, and neurology residents regarding an inpatient case. A root cause analysis was conducted during this M&M that determined the “acute care non-ICU admission” order set was not optimized to fit the management of the neurologically ill patient population. This quality improvement project describes the creation of a new general neurology admission order set that include neurology-specific admission orders that are not included in the current acute care admissions order set. Some of these specific needs include: presence and frequency of neurological exam checks, physical, occupational, and speech therapy evaluations, and holding DVT prophylaxis prior to lumbar punctures.

Lessons learned and next steps: The initial order set has been used by a select number of neurology residents who are giving input on common orders to include, with focus on residents who are rotating through their night float rotation which offers more independence. We expect this new tailored order set will improve ease of admitting patients on a high-volume service as well as reduce commonly “missed” orders, such as PT evaluations and DVT prophylaxis timing in anticipation for procedures. Our next steps include neurology resident wide implementation and adjustments to the order set based on any preliminary feedback.