The Operational and Economic Impact of a Neurovascular Unit in an Acute Care Academic Hospital.
BACKGROUND
There is strong evidence that clinical outcomes are improved for stroke patients admitted to specialized Stroke Units. The Toronto Western Hospital (TWH) created a Neurovascular Unit (NVU) using resources from General Internal Medicine, Neurology, and Neurosurgery for patients with stroke and acute neurovascular conditions. Under resource-constrained conditions, the operational and economic impacts of the Neurovascular Unit were unknown.


METHODS
Retrospective patient-level data was studied from two years prior and one year post NVU implementation. Descriptive statistical analysis and non-parametric testing were conducted on the acute length of stay (LOS), alternate level of care LOS, total cost per bed-day and per visit, and patient flow within each medical service and hospital wide.


RESULTS
The median acute LOS per hospitalization for NVU-eligible patients decreased significantly (p=0.001). For Neurology patients, mean acute LOS decreased from 9.1 days pre-Neurovascular Unit to 7.6 days post and median acute LOS decreased from 6 to 5 days (p=0.002); however, mean alternate level of care LOS per visit more than doubled (from 1.6 to 4.1 days, p=0.001). For the Neurology service, the mean cost per visit decreased by $945, representing a 5% reduction (p=0.042) and the mean cost per bed-day decreased by $233, or 12.5% (p=0.026). Hospital wide, a saving of over C$450 000 was achieved.


CONCLUSIONS
During the first year of operation, the NVU at TWH achieved decreased acute LOS per visit and lowered the total hospitalization cost per year for NVU-eligible patients. Addressing the issue of increased alternate level of care LOS could result in additional efficiencies.
1Centre for Innovation in Complex Care,Toronto,ON,Canada.
Eva
E
Appel
1Centre for Innovation in Complex Care,Toronto,ON,Canada.
Shoshana
S
Hahn-Goldberg
4Department of Surgery,Johns Hopkins University,USA.
Eric
E
Chow
2University Health Network,ON,Canada.
Leanne K
LK
Casaubon
1Centre for Innovation in Complex Care,Toronto,ON,Canada.
Howard B
HB
Abrams
D000208:Acute Disease; D002170:Canada; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D009462:Neurology / Q000191:economics / Q000379:methods; D009493:Neurosurgery / Q000191:economics* / Q000379:methods; D012189:Retrospective Studies; D020521:Stroke / Q000191:economics* / Q000628:therapy*
Canadian study; economic impact; hospital length of stay; neurovascular unit; operational impact; patient flow; stroke unit