The Effect of a Neurocritical Care Service without a Dedicated Neuro-ICU on Quality of Care in Intracerebral Hemorrhage

Background Introduction of neurocritical care services to dedicated neuro-ICUs is associated with improved quality of care. The impact of a neurocritical care service without a dedicated neuro-ICU has not been studied. Methods We retrospectively identified all patients admitted to our institution wi...

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Bibliographic Details
Published in:Neurocritical care 2013-06, Vol.18 (3), p.305-312
Main Authors: Burns, Joseph D., Green, Deborah M., Lau, Helena, Winter, Michael, Koyfman, Feliks, DeFusco, Christina M., Holsapple, James W., Kase, Carlos S.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Blood pressure
Cerebral Hemorrhage - mortality
Cerebral Hemorrhage - therapy
Cohort Studies
Critical care
Critical Care - methods
Critical Care Medicine
Dysphagia
Efficiency
Female
Hospitals
Humans
Intensive
Intensive care
Intensive Care Units
Internal Medicine
Length of Stay - statistics & numerical data
Male
Medicine
Medicine & Public Health
Middle Aged
Mortality
Neurology
Neurology - methods
Occupational therapy
Original Article
Outcome Assessment (Health Care)
Patients
Quality of Health Care
Retrospective Studies
Stroke
Teams
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Summary:Background Introduction of neurocritical care services to dedicated neuro-ICUs is associated with improved quality of care. The impact of a neurocritical care service without a dedicated neuro-ICU has not been studied. Methods We retrospectively identified all patients admitted to our institution with intracerebral hemorrhage (ICH) in two 12-month periods: immediately before the arrival of the first neurointensivist (“before”) and after the neurocritical care service was established (“after”). There was no nursing team, ICU housestaff/physician extender team, or physical unit dedicated to the care of patients with critical neurologic illness during either period. Using an uncontrolled before-after design, we compared clinical outcomes and performance on quality metrics between groups. Results We included 74 patients with primary supratentorial ICH. Mortality, length of stay (LOS), proportion of patients with modified Rankin Score 0–3, and destination on discharge did not differ between groups when adjusted for confounders. Time to first two consecutive systolic blood pressure (SBP) measurements
ISSN:1541-6933
1556-0961
DOI:10.1007/s12028-013-9818-1