Neurosurgical Transitional Care Programme

NCT03593330 | Terminated

• 2 other identifiers: IRAS238850ReDA No: 012315
• Study Type: interventional
• Target: 242
• Locations: 1 country
• Sites: 1

Brief Summary

Readmissions increasingly serve as a metric of hospital performance, inviting quality improvement initiatives in both medicine and surgery. Recently, a readmission reduction program in the United States was associated with significantly shorter length of stay, earlier discharge, and reduced 30-day readmission after elective neurosurgery. These results underscore the importance of patient education and surveillance after hospital discharge, and it would be beneficial to test whether the same approach yields beneficial results in a different health system, the NHS. In this study, the investigators will replicate the Transitional Care Program (TCP) with the goal of decreasing length of stay, improving discharge efficiency, and reducing readmissions in neurosurgical patients by optimizing patient education and post-discharge surveillance.

Conditions

Surgery; Brain Tumor; Brain Tumor, Recurrent; Brain Pathology; Spinal Diseases; Spinal Stenosis; Spinal Fusion; Trigeminal Neuralgia; Hydrocephalus; Fusion of Spine; Aneurysm; SPINAL Fracture; Chiari; Net; Skull Injuries; Brain Cancer; Brain Metastases; Brain Diseases; Brain Lesion; Brain Cyst; Spinal Curvature; Spinal Instability; Spinal Cord Neoplasms

Keywords

Transitional Care; Discharge Planning; Readmission; Elective Neurosurgery; Elective Spinal Surgery; Elective Brain Surgery; Transitional Care Program; TCP

Outcome Measures

Primary Outcomes (1)

• Length of Hospital Stay

  Time from admission until discharge (reported in hours)

  From time of hospital admission until the time of first hospital discharge or time of death from any cause, whichever came first. Assessed up to 4 months post-admission.

Secondary Outcomes (4)

• Hospital Readmission

  From the time of hospital discharge from the original admission until 30 days after hospital discharge

• Discharge before 12:00pm

  This is assessed on the date of discharge from time 00:00 to time 23:59. The actual time of discharge or time of death from any cause, whichever came first, will be noted. Assessed up to 4 months post-admission.

• Cost

  The cost of the hospital admission will be calculated for the time frame from the initial hospital admission until 30 days after hospital discharge, or time of death from any cause.

• Patient Satisfaction scores based on a single survey provided to the patient at the time of discharge.

  From the time of hospital discharge from the original admission up until 2 weeks after discharge

Study Arms (2)

Transitional Care Programme

EXPERIMENTAL

The primary intervention of the Transitional Care Programme (TCP) will be additional patient education, framing of expectations for the hospital course and length of stay, coordinated team preparation for discharge, a dedicated discharge appointment, and a follow up phone call.

Other: Transitional Care Programme

Standard of Care

NO INTERVENTION

Patients are admitted without a pre-determined discharge date. They do not receive a dedicated discharge appointment, and will not receive a follow up phone call 48 hours after discharge.

Interventions

Transitional Care Programme OTHER

These patients will receive a pre-admission overview of their surgery, an anticipated discharge date, and a pre-scheduled discharge appointment to set patient expectations for a shorter hospitalization. On the day of discharge, the patient and his or her caregiver will attend an extended discharge appointment with a TCP-trained nurse. Finally, patients will receive a surveillance phone call 48 hours after discharge.

Also known as: Discharge Planning

Transitional Care Programme

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients are eligible for the TCP if scheduled for elective neurological surgery (including spinal surgery performed by an orthopedic surgeon) and were expected to have a discharge disposition to home.

You may not qualify if:

• Patients with an anticipated discharge to a facility other than home
• Patients with an anticipated discharge to home who are then discharged to a facility other than home will be excluded from the statistical analysis

Sponsors & Collaborators

• Barts & The London NHS Trust: lead
• Brigham and Women's Hospital: collaborator
• Harvard Medical School (HMS and HSDM): collaborator

Study Sites (1)

Bart's Health NHS Trust

London, United Kingdom

Location

Related Publications (3)

• Robertson FC, Logsdon JL, Dasenbrock HH, Yan SC, Raftery SM, Smith TR, Gormley WB. Transitional care services: a quality and safety process improvement program in neurosurgery. J Neurosurg. 2018 May;128(5):1570-1577. doi: 10.3171/2017.2.JNS161770. Epub 2017 Jul 14.

  PMID: 28707992 BACKGROUND

• Jones CE, Hollis RH, Wahl TS, Oriel BS, Itani KM, Morris MS, Hawn MT. Transitional care interventions and hospital readmissions in surgical populations: a systematic review. Am J Surg. 2016 Aug;212(2):327-35. doi: 10.1016/j.amjsurg.2016.04.004. Epub 2016 Jun 1.

  PMID: 27353404 BACKGROUND

• Verhaegh KJ, MacNeil-Vroomen JL, Eslami S, Geerlings SE, de Rooij SE, Buurman BM. Transitional care interventions prevent hospital readmissions for adults with chronic illnesses. Health Aff (Millwood). 2014 Sep;33(9):1531-9. doi: 10.1377/hlthaff.2014.0160.

  PMID: 25201657 BACKGROUND

MeSH Terms

Conditions

Brain Neoplasms; Spinal Diseases; Spinal Stenosis; Trigeminal Neuralgia; Hydrocephalus; Aneurysm; Spinal Fractures; Brain Diseases; Spinal Curvatures; Spinal Cord Neoplasms

Interventions

Patient Discharge

Condition Hierarchy (Ancestors)

Central Nervous System Neoplasms; Nervous System Neoplasms; Neoplasms by Site; Neoplasms; Central Nervous System Diseases; Nervous System Diseases; Bone Diseases; Musculoskeletal Diseases; Trigeminal Nerve Diseases; Facial Neuralgia; Facial Nerve Diseases; Mouth Diseases; Stomatognathic Diseases; Cranial Nerve Diseases; Vascular Diseases; Cardiovascular Diseases; Spinal Injuries; Back Injuries; Wounds and Injuries; Fractures, Bone; Spinal Cord Diseases

Intervention Hierarchy (Ancestors)

Continuity of Patient Care; Patient Care; Therapeutics; Hospitalization; Health Services; Health Care Facilities Workforce and Services; Primary Health Care; Comprehensive Health Care; Patient Care Management; Health Services Administration

Study Officials

• Edward McKintosh, FRCS(SN) PhD

  Barts Health

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: All eligible patients will be consented to participate in the study. If they consent, a non-clinician study team member will randomise the patient into the control or intervention arm. Thereafter, all members of the care team will be notified of the patient's allocation in order to deliver the TCP.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Patients will be randomised into two groups: standard of care or Transitional Care Programme (TCP)

Study Record Dates

• First Submitted: June 5, 2018
• First Posted: July 20, 2018
• Study Start: May 30, 2019
• Primary Completion: August 18, 2019
• Study Completion: August 30, 2019
• Last Updated: May 2, 2025

Record last verified: 2025-04

Locations

GB (1)