Effects of Appointing a Full-Time Neurointensivist to Run a Closed-Type Neurological Intensive Care Unit
10.3988/jcn.2019.15.3.360
- Author:
Myung Ah KO
1
;
Jung Hwa LEE
;
Joong Goo KIM
;
Suyeon JEONG
;
Dong Wha KANG
;
Chae Man LIM
;
Sang Ahm LEE
;
Kwang Kuk KIM
;
Sang Beom JEON
Author Information
1. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sbjeonmd@gmail.com
- Publication Type:Original Article
- Keywords:
critical care;
intensive care unit;
neurology;
critical care outcomes
- MeSH:
Critical Care Outcomes;
Critical Care;
Humans;
Intensive Care Units;
Korea;
Length of Stay;
Medical Records;
Mortality;
Neurology;
Proportional Hazards Models;
Referral and Consultation;
Seoul
- From:Journal of Clinical Neurology
2019;15(3):360-368
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND AND PURPOSE: To investigate whether appointing a full-time neurointensivist to manage a closed-type neurological intensive care unit (NRICU) improves the quality of critical care and patient outcomes. METHODS: This study included patients admitted to the NRICU at a university hospital in Seoul, Korea. Two time periods were defined according to the presence of a neurointensivist in the preexisting open-type NRICU: the before and after periods. Hospital medical records were queried and compared between these two time periods, as were the biannual satisfaction survey results for the families of patients. RESULTS: Of the 15,210 patients in the neurology department, 2,199 were admitted to the NRICU (n=995 and 1,204 during the before and after periods, respectively; p<0.001). The length of stay was shorter during the after than during the before period in both the NRICU (3 vs. 4 days; p<0.001) and the hospital overall (12.5 vs. 14.0 days; p<0.001). Neurological consultations (2,070 vs. 3,097; p<0.001) and intrahospital transfers from general intensive care units to the NRICU (21 vs. 40; p=0.111) increased from the before to after the period. The mean satisfaction scores of the families of the patients also increased, from 78.3 to 89.7. In a Cox proportional hazards model, appointing a neurointensivist did not result in a statistically significant change in 6-month mortality (hazard ratio, 0.82; 95% confidence interval, 0.652–1.031; p=0.089). CONCLUSIONS: Appointing a full-time neurointensivist to manage a closed-type NRICU had beneficial effects on quality indicators and patient outcomes.
