title: Reducing length of stay in aneurysmal subarachnoid hemorrhage: A three year institutional experience.
abstract: Hospital length of stay is a common metric of excellence in health care. With limited data evaluating hospital length of stay (LOS) and cost in subarachnoid hemorrhage (SAH), in this study we explore multiple prognostic factors and present our institutional experience in shortening LOS. 345 SAH patients were reviewed over a three year period. Patient demographics, hemorrhage grade, hospital course, hospital costs, and LOS were reviewed. Angiogram-negative SAH, Hunt and Hess (HH) Grade 5, and early mortalities were excluded. During this period a physician-led daily multidisciplinary huddle was established to identify and expedite patient discharge needs. 174 patients met inclusion criteria. Significant predictors of increased hospital LOS on univariate analysis included higher HH grade, hydrocephalus, need for ventriculostomy or ventriculoperitoneal shunt, clinical vasospasm, pneumonia, respiratory failure, deep venous thrombosis, and urinary tract infection. Need for shunt, clinical vasospasm, and pneumonia remained significant on multivariate analysis. Mean LOS times decreased to less than those cited in earlier studies, with mean hospital LOS dropping from 21.6days to 14.1. Total hospital costs per SAH patient decreased from $328K to $269K. Readmission rate and breakdown by patient discharge site remained unchanged. Need for ventriculoperitoneal shunt, clinical vasospasm, and pneumonia were found predictive of longer LOS in SAH patients. A physician-led daily multidisciplinary huddle is a potentially valuable tool to identify patient discharge needs and lower LOS and cost in SAH patients.
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA. Electronic address: alaraj@uic.edu.
authors.forename: Ali
authors.initials: A
authors.lastname: Alaraj
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA. Electronic address: aessam@uic.edu.
authors.forename: Ahmed E
authors.initials: AE
authors.lastname: Hussein
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA. Electronic address: desfah2@uic.edu.
authors.forename: Darian R
authors.initials: DR
authors.lastname: Esfahani
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA. Electronic address: hanjani@uic.edu.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Amin-Hanjani
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA. Electronic address: valetich@uic.edu.
authors.forename: Victor A
authors.initials: VA
authors.lastname: Aletich
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA. Electronic address: fcharbel@uic.edu.
authors.forename: Fady T
authors.initials: FT
authors.lastname: Charbel
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data
keywords: Cerebral aneurysm; Cost; Hydrocephalus; Length of stay; Rehabilitation; Subarachnoid hemorrhage