J Clin Neurol.  2019 Jul;15(3):360-368. 10.3988/jcn.2019.15.3.360.

Effects of Appointing a Full-Time Neurointensivist to Run a Closed-Type Neurological Intensive Care Unit

Affiliations
  • 1Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sbjeonmd@gmail.com
  • 2Department of Neurology, Jeju National University Hospital, Jeju, Korea.
  • 3Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

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.

Keyword

critical care; intensive care unit; neurology; critical care outcomes

MeSH Terms

Critical Care Outcomes
Critical Care*
Humans
Intensive Care Units*
Korea
Length of Stay
Medical Records
Mortality
Neurology
Proportional Hazards Models
Referral and Consultation
Seoul

Figure

  • Fig. 1 Presence of a neurointensivist and 6-month survival outcomes. Kaplan-Meier curves showing the proportion of surviving patients stratified by whether a neurointensivist was appointed.


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