Impact of a neuroscience intensive care unit on neurosurgical patient outcomes and cost of care - Evidence-based support for an intensivist-directed specialty ICU model of care

Analysis of patient data from a new neuroscience intensive care unit (NSICU ) permitted evaluation of whether such a specialty ICU favorably altered cl inical outcomes in critically ill neuroscience patients, and whether such a care model produced an efficient use of resources. A retrospective review was performed to compare (1) the clinical outcomes, as defined by percent m ortality and disposition at discharge, between patients with a primary diag nosis of intracerebral hemorrhage treated in 1995 in medical or surgical IC Us and those treated in the same medical facility in an NSICU in 1997; and (2) the efficiency of care: as defined by length of ICU stay, total cost of care, and specific resource use, between patients treated in the NSICU and national benchmark standards For general ICUs during the 1997 fiscal year (Fi). In the latter, extracted patient population data on neurosurgery pati ents requiring ICU treatment during FY 1997 were used with the following ad jacent-disease related group (A-DRG)-coded diseases: craniotomy with and wi thout coma or intracerebral hemorrhage, and skull fracture with and without coma lasting longer than 1 hour. outcome measures of percent mortality and disposition at discharge in patients with intracerebral hemorrhage were si gnificantly improved (P < .05), compared with those in a similar cohort tre ated 2 years earlier in a general ICU setting. Also, patients treated in th e NSICU had shorter hospital stays (P < .01) and lower total costs of care (P < .01) than a national benchmark. The data suggest that a neuroscience s pecialty ICU arena staffed by specialty-trained intensivists and nurses is beneficial.