Mandatory Intensivist Management Decreases Length of Stay, Facilitates an Increase in Admissions and Minimizes Closure of a Neurocritical Care Unit

Abstract

Background: The primary objectives of this study were to identify patient and community benefits of mandatory intensivist management in a neurocritical care (NCC) unit. Our hospital recently mandated intensivist management for patients admitted to the NCC unit. As one of the only comprehensive stroke centers in Orlando, an unacceptably high number of patients were being denied admission because of overcapacity. We compared length of stay (LOS), complications, outcomes, total admissions, and emergency transfer center closure rates before and after implementation of mandatory intensivist management.

Methods: A retrospective review comparing 1551 patients admitted to a 20 bed NCC unit from November 1, 2009 to October 31, 2010 (prior to mandatory intensivist management) with 1702 patients admitted from January 1, 2011 to December 31, 2011 (after the requirement) was performed. This included examining LOS, Acute Physiology and Chronic Health Evaluation III (APACHE) scores, service line closure rates, and mortality during both time periods.

Results: Analysis revealed that despite comparable APACHE scores, implementation of mandatory intensivist management reduced overall NCC LOS, 4.6 versus 3.7 days, (p < 0.01) and increased the number of monthly admissions, 129 versus 142, (p = 0.02). The percentage of patients declined admission because of a closed service line was reduced from 12.36 to 5.66 %, (p = 0.02). Mortality and infection rates remained unchanged.

Conclusions: Implementation of mandatory intensivist management in the NCC unit decreased LOS, increased admissions, and decreased service line closure rates, while maintaining patient care.

Keywords: Intensivist; Length of stay; Neurocritical care; Patient outcomes; Quality of health care.