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KMID : 1130620190150030360
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Journal of Clinical Neurology
2019 Volume.15 No. 3 p.360 ~ p.368
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Effects of Appointing a Full-Time Neurointensivist to Run a Closed-Type Neurological Intensive Care Unit
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Ko Myung-Ah
Lee Jung-Hwa
Kim Joong-Goo
Jeong Su-Yeon
Kang Dong-Wha
Lim Chae-Man
Lee Sang-Ahm
Kim Kwang-Kuk
Jeon Sang-Beom
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Abstract
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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.
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KEYWORD
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critical care, intensive care unit, neurology, critical care outcomes
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