scholarly journals Selective Intensive Care Unit Admission After Adult Supratentorial Tumor Craniotomy: Complications, Length of Stay, and Costs

Neurosurgery ◽  
2019 ◽  
Vol 86 (1) ◽  
pp. E54-E59 ◽  
Author(s):  
Mark ter Laan ◽  
Suzanne Roelofs ◽  
Ineke Van Huet ◽  
Eddy M M Adang ◽  
Ronald H M A Bartels
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Cost Reduction ◽  
Hospital Costs ◽  
Qualitative Evaluation ◽  
Complication Rates ◽  
Supratentorial Tumor ◽  
Before And After ◽  
Supratentorial Tumors

Abstract BACKGROUND Admitting patients to an intensive care or medium care unit (ICU/MCU) after adult supratentorial tumor craniotomy remains common practice even though some studies have suggested lower level care is sufficient for selected patients. We have introduced a “no ICU, unless” policy for tumor craniotomy patients. OBJECTIVE To provide a quieter postoperative environment for patients, reduce the burden on the ICU department, and to evaluate whether costs can be reduced. METHODS A cohort study was performed comparing patients that underwent tumor craniotomy for supratentorial tumors during 1 yr after introduction (n = 109) of the new policy with the year before (n = 107). Rate of complications was evaluated, as was the length of stay and patient satisfaction using qualitative evaluation. Finally, costs were evaluated comparing the situation before and after implementation of the new protocol. RESULTS A reduction in ICU/MCU admittance from 64% to 24% of patients was found resulting in 13.3% cost reduction (€1950 per case), without increasing the length of stay at the ward. The length of stay in the hospital was similar. Complications were significantly reduced after implementing the new policy (0.98 vs 0.53 per patient, P = .003). Patients that were interviewed after the new policy reported feeling safe and at ease at the ward. CONCLUSION Changing our policy from “ICU, unless” to “no ICU, unless” reduced complication rates and length of stay in the hospital while keeping patients satisfied. Hospital costs related to the admission have been significantly reduced by the new policy.

scholarly journals Intensive care unit admission protocol controlled by intensivists can reduce transfer delays from the emergency department in critically ill patients

2018 ◽  
Vol 26 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Ji Eun Kim ◽  
Seul Lee ◽  
Jinwoo Jeong ◽  
Dong Hyun Lee ◽  
Jin-Heon Jeong
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Unit Admission ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Unit Length ◽  
Intensive Care Unit Length ◽  
Before And After

Background: Delayed transfer of patients from the emergency department to the intensive care unit is associated with adverse clinical outcomes. Critically ill patients with delayed admission to the intensive care unit had higher in-hospital mortality and increased hospital length of stay. Objectives: We investigated the effects of an intensive care unit admission protocol controlled by intensivists on the emergency department length of stay among critically ill patients. Methods: We designed the intensive care unit admission protocol to reduce the emergency department length of stay in critically ill patients. Full-time intensivists determined intensive care unit admission priorities based on the severity of illness. Data were gathered from patients who were admitted from the emergency department to the intensive care unit between 1 April 2016 and 30 November 2016. We retrospectively analyzed the clinical data and compared the emergency department length of stay between patients admitted from the emergency department to the intensive care unit before and after intervention. Results: We included 292 patients, 120 and 172 were admitted before and after application of the intensive care unit admission protocol, respectively. The demographic characteristics did not differ significantly between the groups. After intervention, the overall emergency department length of stay decreased significantly from 1045.5 (425.3–1665.3) min to 392.0 (279.3–686.8) min (p < 0.001). Intensive care unit length of stay also significantly decreased from 6.0 (4.0–11.8) days to 5.0 (3.0–10.0) days (p = 0.015). Conclusion: Our findings suggest that introduction of the intensive care unit admission protocol controlled by intensivists successfully decreased the emergency department length of stay and intensive care unit length of stay among critically ill patients at our institution.

scholarly journals TRANSCATHETER VERSUS SURGICAL AORTIC VALVE REPLACEMENT: FIRST EXPERIENCE WITH A NEW TAVI SYSTEM

2021 ◽  
Vol 74 (4) ◽  
pp. 856-863
Author(s):  
Glib I. Yemets ◽  
Oleksandra V. Telehuzova ◽  
Andrii V. Maksymenko ◽  
Georgiy B. Mankovsky ◽  
Yevhen Y. Marushko ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Unit Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Early Results ◽  
Significant Difference

The aim: to reveal early results after transapical TAVI with a new self-manufactured XPand system, comparing them with SAVR and common transfemoral TAVI outcomes. Materials and methods: Eighty-four patients (mean age 79,5±10,2 years) with severe aortic stenosis were operated on from January 2016 to February 2019. Nine patients had undergone the TAVI (two with transfemoral access route and seven with transapical, using the XPand system). SAVR was performed in seventy five patients. For the latter, we estimate the in-hospital mortality, complication rates, intensive care unit and total hospital length of stay. Results: There was no intraoperative mortality. In the TAVI group, the frequency of intraoperative and postoperative complications was significantly lower (p<0.01). The SAVR group showed higher median intensive care unit length of stay (104 h, IQR 72 –112 versus 29 h, IQR 20–35,p<0.01), hemodynamic support duration (100,98 ± 78 minutes versus 11.13 ± 7.89 minutes, p<0.01) and paravalvular leakage causality (9,33% versus 0%). No significant difference in results depending on the TAVI access routes was obtained. Conclusions: We conclude that TAVI provides an alternative to the conventional approach in patients with severe aortic stenosis aged over 75 years. No significant difference in mortality rate between TAVI and SAVR groups was found. A novel transapical TAVI device is associated with good short-term results and lower complication rate.

scholarly journals Letter: Selective Intensive Care Unit Admission After Adult Supratentorial Tumor Craniotomy: Complications, Length of Stay, and Costs

Neurosurgery ◽  
2020 ◽  
Vol 86 (6) ◽  
pp. E572-E573 ◽  
Author(s):  
Luis-Rafael Moscote-Salazar ◽  
Ezequiel Garcia-Ballestas ◽  
Rafael Martinez-Perez ◽  
Amit Agrawal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Unit Admission ◽  
Supratentorial Tumor

scholarly journals The impact of intensive care unit physician staffing change at a community hospital

2022 ◽  
Vol 10 ◽  
pp. 205031212110664
Author(s):  
Christopher D Adams ◽  
Luigi Brunetti ◽  
Liza Davidov ◽  
Jose Mujia ◽  
Michael Rodricks
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Patient Care ◽  
Hospital Costs ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Mechanically Ventilated ◽  
Unit Model

Objectives: A high-intensity staffing model has been defined as either mandatory intensivist consultation or a closed intensive care unit in which intensivists manage all aspects of patient care. In the current climate of limited healthcare resources, transitioning to a closed intensive care unit model may lead to significant improvements in patient care and resource utilization. Methods: This is a single-center, retrospective cohort study of all mechanically ventilated intensive care unit admissions in the pre-intensive care unit closure period of 1 October 2014 to 30 September 2015 as compared with the post-intensive care unit closure period of 1 November 2015 to 31 October 2016. Patient demographics as well as outcome data (duration of mechanical ventilation, length of stay, direct costs, complications, and mortality) were abstracted from the electronic health record. All data were analyzed using descriptive and inferential statistics. Regression analyses were used to adjust outcomes for potential confounders. Results: A total of 549 mechanically ventilated patients were included in our analysis: 285 patients in the pre-closure cohort and 264 patients in the post-closure cohort. After adjusting for confounders, there was no significant difference in mortality rates between the pre-closure (40.7%) and post-closure (38.6%) groups (adjusted odds ratio = 0.82; 95% confidence interval = 0.56–1.18; p = 0.283). The post-closure cohort was found to have significant reductions in duration of mechanical ventilation (3.71–1.50 days; p < 0.01), intensive care unit length of stay (5.8–2.7 days; p < 0.01), hospital length of stay (10.9–7.3 days; p < 0.01), and direct hospital costs (US $16,197–US $12,731; p = 0.009). Patient complications were also significantly reduced post-intensive care unit closure. Conclusion: Although a closed intensive care unit model in our analysis did not lead to a statistical difference in mortality, it did demonstrate multiple beneficial outcomes including reduced ventilator duration, decreased intensive care unit and hospital length of stay, fewer patient complications, and reduced direct hospital costs.

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