Development of Criteria, Dashboard Metrics, and Processes for Pituitary Center of Excellence
Eric Wang, Paul Gardner, Carl Snyderman, Andrew Venteicher, Philippe Lavigne, Omar Ahmed, Nathalia Velasquez
Introduction: Centers of Excellence have been promoted to improve quality of care. This concept has yet to be formally adopted for pituitary surgery. Evidence-based institutional criteria, metrics, and processes for a Pituitary Tumor Center of Excellence (PTCE) have been recently established at our center.
Objective: Develop specific criteria, metrics, and processes for PTCE. This was supported by our institution’s outcomes data and a contemporary literature review.
Methods: Data of patients with diagnosis or procedure codes for pituitary adenoma from 2012 to 2017 were examined for all hospitals within our healthcare system. Patient factors, tumor characteristics, and outcomes data (post-operative complications, endocrine outcomes, vision outcomes, extent of resection), were extracted. Medical literature was reviewed for comparison.
Results: Criteria for designation of PTCE include volume of surgery, multidisciplinary care, and clinical care processes. Outcome metrics were defined based on our center’s outcomes as well as an appraisal of the contemporary literature, and include 30-day mortality (<1%), vascular injuries and post-op stroke (<1%), post-operative cerebrospinal fluid (CSF) leak (<5%), post-operative meningitis (<1%), diabetes insipidus or hypopituitarism persisting beyond one month post-operatively (<5%), average length of stay (<3 days), and 30-day readmission (<10%). An automated data mining system has been developed for our institution to generate surgeon and site specific pituitary surgery outcomes data in real-time (Figure 1).
Conclusions: Evidence-based metrics and criteria have been proposed to establish our PTCE. A state-of-the-art automated electronic system has also been created to track pituitary surgery outcomes within our PTCE and across our large health system.