Impact of a Neuroscience Intensive Care Unit on Neurosurgical Patient Outcomes and Cost of Care

Abstract

Analysis of patient data from a new neuroscience intensive care unit (NSICU) permitted evaluation of whether such a specialty ICU favorably altered clinical outcomes in critically ill neuroscience patients, and whether such a care model produced an efficient use of resources. A retrospective review was performed to compare (1) the clinical outcomes, as defined by percent mortality and disposition at discharge, between patients with a primary diagnosis of intracerebral hemorrhage treated in 1995 in medical or surgical ICUs and those treated in the same medical facility in an NSICU in 1997; and (2) the efficiency of care, as defined by length of ICU stay, total cost of care, and specific resource use, between patients treated in the NSICU and national benchmark standards for general ICUs during the 1997 fiscal year (FY). In the latter, extracted patient population data on neurosurgery patients requiring ICU treatment during FY 1997 were used with the following adjacent-disease related group (A-DRG)-coded diseases: craniotomy with and without coma or intracerebral hemorrhage, and skull fracture with and without coma lasting longer than 1 hour. Outcome measures of percent mortality and disposition at discharge in patients with intracerebral hemorrhage were significantly improved (P < .05), compared with those in a similar cohort treated 2 years earlier in a general ICU setting. Also, patients treated in the NSICU had shorter hospital stays (P < .01 ) and lower total costs of care (P < .01) than a national benchmark. The data suggest that a neuroscience specialty ICU arena staffed by specialty-trained intensivists and nurses is beneficial.

The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study

“…4 Mirski et al also found that introducing a team to ICUs that is specifically trained for neuroscience critical care decreased mortality from 36% to 19% and increased the proportion of good outcomes in patients with intracranial hemorrhage from 48% to 69%. 5 Compared with these reports, our patients in both groups had much lower mortality rates (0.96%) and much improved neurological outcomes (complication rates were \ 5%). Taking into consideration that baseline outcomes were considerably improved in our patient population, it would be difficult to improve patient outcome without any interventions.…”

“…2,3 In addition, it has been reported that utilization of a neurointensive care unit team decreased mortality rates, shortened hospital length of stay, and improved patient outcomes in the neurological and neurosurgical populations. 4,5 Collectively, it is conceivable that intensive care has a significant impact on critically ill patient outcomes. However, it has not been determined whether intensive care based on continuous monitoring (electrocardiogram (ECG), blood pressure, and pulse oximetry [SpO 2 ]) and frequent neurologic evaluation by ICU staff has a significant impact on elective neurosurgical patient outcome in those who are in good physical condition.…”

Do Neurocritical Care Units Save Lives? Measuring The Impact of Specialized ICUs

“…We identified 12 studies, involving 24,520 patients, which presented original data comparing models of care for critically ill neurologic patients [3][4][5][6][7][8][9][10][11][12][13][14]. Four studies assessing subgroups derived from previously published data were excluded (see Electronic Supplementary Material) [15][16][17][18].…”

Where Should Critically Ill Neurologic Brain Hemorrhage Patients Go and Can Transfer Harm Them?

“…This change has been fueled by the emergence of specialists who run and work in specialty units like the Neurocritical care unit (NCCU). These units have been shown to reduce morbidity, mortality, and the length of stay for critically ill neurologic patients [1][2][3]. The improved care in these units is driven by two underlying factors.…”

“…The improved care in these units is driven by two underlying factors. The availability of technological interventions that are performed in the context of neurological specialty units and the concentration of neurological patients in a single location were the judgment and experience of specialty providers results in better outcomes [1][2][3].…”