1 Division of Critical Care and Palliative Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
2 Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
J Intensive Care Med. 2019 Feb;34(2):109-114. doi: 10.1177/0885066617706651. Epub 2017 Apr 26.
: With an aging population and increasing numbers of intensive care unit admissions, novel ways of providing quality care at reduced cost are required. Closed neurointensive care units improve outcomes for patients with critical neurological conditions, including decreased mortality and length of stay (LOS). Small studies have demonstrated the safety of intermediate-level units for selected patient populations. However, few studies analyze both cost and safety outcomes of these units. This retrospective study assessed clinical and cost-related outcomes in an intermediate-level neurosciences acute care unit (NACU) before and after the addition of an intensivist to the unit's care team.
: Starting in October 2011, an intensivist-led model was adopted in a 16-bed NACU unit, including daytime coverage by a dedicated intensivist. Data were obtained from all patients admitted 1 year prior to and 2 years after this intervention. Primary outcomes were LOS and hospital costs. Safety outcomes included mortality and readmissions. Descriptive and analytic statistics were calculated. Individual and total patient costs were calculated based on per-day NACU and ward cost estimates and significance measured using bootstrapping.
: A total of 2931 patients were included over the study period. Patients were on average 59.5 years and 53% male. The most common reasons for admission were central nervous system (CNS) tumor (27.6%), ischemic stroke (27%), and subarachnoid hemorrhage (11%). Following the introduction of an intensivist, there was a significant reduction in NACU and hospital LOS, by 1 day and 3 days, respectively. There were no differences in readmissions or mortality. Adding an intensivist produced an individual cost savings of US$963 in NACU and US$2687 per patient total hospital stay.
: An intensivist-led model of intermediate-level neurointensive care staffed by intensivists is safe, decreases LOS, and produces cost savings in a system increasingly strained to provide quality neurocritical care.
随着人口老龄化和重症监护病房入院人数的增加，需要寻找新的方法以降低成本提供高质量的护理。封闭式神经重症监护病房改善了危重神经疾病患者的预后，包括降低死亡率和住院时间（LOS）。小型研究已经证明了中级单位对选定患者群体的安全性。但是，很少有研究分析这些单位的成本和安全结果。这项回顾性研究评估了在增加一名重症监护医生到单位护理团队后，中级神经科学急症护理病房（NACU）的临床和成本相关结果。
从 2011 年 10 月开始，在一个 16 张床位的 NACU 病房中采用了由重症监护医生主导的模式，包括由专门的重症监护医生进行日间覆盖。数据来自干预前一年和干预后两年期间所有入院的患者。主要结果是 LOS 和住院费用。安全结果包括死亡率和再入院率。计算了描述性和分析性统计数据。根据 NACU 和病房的每日费用估算值计算了单个和总患者费用，并使用自举法测量了其显著性。
在研究期间共纳入了 2931 名患者。患者平均年龄为 59.5 岁，53％为男性。入院的最常见原因是中枢神经系统（CNS）肿瘤（27.6％），缺血性中风（27％）和蛛网膜下腔出血（11％）。引入重症监护医生后，NACU 和医院 LOS 分别缩短了 1 天和 3 天。再入院率或死亡率没有差异。引入重症监护医生可使 NACU 的每位患者个体成本节省 963 美元，总住院费用节省 2687 美元。
由重症监护医生主导的中级神经重症监护人员配备模式是安全的，可以降低 LOS，并在系统中提供高质量的神经危重症护理的压力越来越大的情况下节省成本。
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