The Cerebral Palsy Research Network (CPRN) is preparing to roll out its first quality improvement (QI) protocol to reduce infections from the implantation of an intrathecal baclofen (ITB) pump. Baclofen is a drug used to reduce spasticity. For some patients, the permanent placement of a baclofen pump can provide continuous reduction in spasticity alleviating the need to take oral medication on a daily basis. ITB pumps have a high infection rate (approximately 9%).1 An ITB pump infection requires the patient to have the pump removed while the infection is treated and then implanted again. Treating the infection typically requires two weeks of intravenous anti-biotics before re-implanting the pump six weeks later. CPRN is planning to use QI methodology to reduce the infection rate for ITB pumps.
Quality improvement methodology involves systematic activities that are organized and implemented by an organization to monitor, assess, and improve its quality of health care and it has its origins in manufacturing.2 The use of QI has gained significant traction in healthcare in last two decades following significant reports from the Institute of Medicine in 1994 and 2003. CPRN was founded to improve outcomes in cerebral palsy through clinical research and quality improvement.
The CPRN baclofen pump QI effort is led by Dr. Robert Bollo who is a neurosurgeon at Primary Children’s Hospital in Salt Lake City, Utah. The CPRN ITB pump QI protocol builds off of Dr. Bollo’s experience as a neurosurgeon with the Hydrocephalus Clinical Research Network.
HCRN used QI to reduce the rate of shunt infections by 35%.3 This is significant because shunt infections used to occur at a similar rate to ITB pump infections – approximately 8.5%. CPRN Executive Committee member Dr. Amy Bailes from Cincinnati Children’s oversees CPRN’s quality improvement initiatives.
CPRN will pilot the ITB pump quality effort at three sites initially including Children’s of Alabama in Birmingham, Primary Children’s Hospital in Salt Lake City, and Seattle Children’s Hospital. The goal of reducing ITB pump infection rates will improve the outcomes of people with CP.
1Spader, Heather S., et al. “Risk Factors for Baclofen Pump Infection in Children: a Multivariate Analysis.” Journal of Neurosurgery: Pediatrics, vol. 17, no. 6, June 2016, pp. 756–762., doi:10.3171/2015.11.peds15421.
2“Quality Improvement.” Health Resources and Services Administration, Health and Human Services, Apr. 2011, www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf.
3Kestle, John R. W., et al. “A Standardized Protocol to Reduce Cerebrospinal Fluid Shunt Infection: The Hydrocephalus Clinical Research Network Quality Improvement Initiative.” Journal of Neurosurgery: Pediatrics, vol. 8, no. 1, 2011, pp. 22–29., doi:10.3171/2011.4.peds10551.