The impact of a neurointensivist-led team on a semiclosed neurosciences intensive care unit.
OBJECTIVE
To evaluate the impact of a newly appointed neurointensivist on neurosciences intensive care unit (NICU) patient outcomes and quality of care variables.


METHODS
Observational cohort with historical controls.


METHODS
Ten-bed neurointensive care unit in tertiary university hospital.


METHODS
Mortality, length of stay (LOS), and discharge disposition of all patients admitted to the NICU were compared between two 19-month periods, before and after the appointment of a neurointensivist. Data regarding these patients were collected using the hospital database and the University Hospitals Consortium database. Individual patient medical records were reviewed for major complications and important prognostic variable documentation.


METHODS
Appointment of a neurointensivist.


RESULTS
We analyzed 1,087 patients before and 1,279 after the neurointensivist's appointment. The unadjusted in-hospital mortality decreased from 10.1% in the before to 9.1% in the after period (95% confidence interval, -1.3 to 3%, relative mortality reduction of 9.9%), but this decrease was significantly different than the expected increase of 1.4% in University Hospitals Consortium mortality during the same period (p = .048). The unadjusted mortality in the NICU decreased from 8% to 6.3% (95% confidence interval, -0.5 to 4, relative mortality reduction 21%) and mean NICU LOS from 3.5 to 2.9 days (95% confidence interval, 0.2 to 0.9, relative NICU LOS reduction 17%). A significant 42% reduction of the risk of death during the first 3 days of NICU admission (p = .003) and a 12% greater risk for NICU discharge (p = .02) were found in the after period in multivariate proportional hazard models. Discharge home increased from 51.7% in the before to 59.7% in the after period (95% confidence interval, 4 to 12, relative increase of 15%) and discharge to a nursing home decreased from 8.1% to 6.8% (95% confidence interval, -1 to 4, relative decrease of 16%). Although a higher total number of complications occurred in the after period, fewer of them occurred in the NICU (odds ratio, 0.2; 95% confidence interval, 0.08 to 0.54, p = .001); this may possibly be due to the better documentation by the NICU team in the after period.


CONCLUSIONS
The institution of a neurointensivist-led team model was associated with an independent positive impact on patient outcomes, including a lower intensive care unit mortality, LOS, and discharge to a skilled nursing facility and a higher discharge home.
Varelas
Panayiotis N
PN
Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
Conti
Mary M
MM
Spanaki
Marianna V
MV
Potts
Eric
E
Bradford
Deborah
D
Sunstrom
Cindy
C
Fedder
Wende
W
Hacein Bey
Lotfi
L
Jaradeh
Safwan
S
Gennarelli
Thomas A
TA
D000328:Adult; D000368:Aged; D002423:Cause of Death; D003422:Critical Care / Q000458:organization & administration*; D004282:Documentation; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D015999:Multivariate Analysis; D009462:Neurology / Q000458:organization & administration*; D009493:Neurosurgery / Q000458:organization & administration*; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge / Q000706:statistics & numerical data; D015397:Program Evaluation; D016016:Proportional Hazards Models; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis