The Effect of a Neurocritical Care Service without a Dedicated Neuro-ICU on Quality of Care in Intracerebral Hemorrhage

Burns, Joseph D.; Green, Deborah; Lau, Helena; Winter, Michael; Koyfman, Feliks; DeFusco, Christina; Holsapple, James; Kase, Carlos S.

doi:10.1007/s12028-013-9818-1

Cited by 26 publications

(22 citation statements)

References 25 publications

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“…The impact of neurocritical care/neuro-intensivists’ care on outcomes in patients with life-threatening neurological and neurosurgical illnesses has been reported by various authors [ 90 – 95 ]. In particular, the proven efficacy of a neurointensivist-managed neurocritical/intensive care unit for patients with aneurysmal SAH has been frequently reported.…”

Section: Reviewmentioning

confidence: 99%

Neurocritical care update

Kuroda

2016

j intensive care

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This update comprises six important topics under neurocritical care that require reevaluation. For post-cardiac arrest brain injury, the evaluation of the injury and its corresponding therapy, including temperature modulation, is required. Analgosedation for target temperature management is an essential strategy to prevent shivering and minimizes endogenous stress induced by catecholamine surges. For severe traumatic brain injury, the diverse effects of therapeutic hypothermia depend on the complicated pathophysiology of the condition. Continuous electroencephalogram monitoring is an essential tool for detecting nonconvulsive status epilepticus in the intensive care unit (ICU). Neurocritical care, including advanced hemodynamic monitoring, is a fundamental approach for delayed cerebral ischemia following subarachnoid hemorrhage. We must be mindful of the high percentage of ICU patients who may develop sepsis-associated brain dysfunction.

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Section: Reviewmentioning

confidence: 99%

Neurocritical care update

Kuroda

2016

j intensive care

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“…Studies have shown that a neurointensivist managing a NSICU improves outcomes and shortens length of stays in all neurocritically ill patients and also improves documentation [ 5 – 9 ]. Similar improvements after dedicated neurointensivists have been demonstrated in patients with ischemic stroke [ 9 – 14 ], subarachnoid hemorrhage [ 15 , 16 ], traumatic brain injury [ 17 , 18 ], intracerebral hemorrhage [ 19 ], and neuromuscular respiratory failure [ 20 ]. These studies, however, lack information on patient and family satisfaction concomitantly with the improvement in other clinical quality metrics.…”

Section: Introductionmentioning

confidence: 61%

Improvement in Quality Metrics Outcomes and Patient and Family Satisfaction in a Neurosciences Intensive Care Unit after Creation of a Dedicated Neurocritical Care Team

Sarpong

Nattanmai

Schelp

et al. 2017

Critical Care Research and Practice

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Introduction Dedicated neurointensivists have been shown to improve outcome measurements in the neurosciences intensive care unit (NSICU). Quality outcome data in relation to patient and family satisfaction is lacking. This study evaluated the impact of newly appointed neurointensivists and creation of a neurocritical care team on quality outcome measures including patient satisfaction in a NSICU. Methods This is a retrospective study of data over 36 months from a 14-bed NSICU evaluating quality outcome measures and anonymous patient satisfaction questionnaires before and after neurointensivists appointment. Results After appointment of neurointensivists, patient acuity of the NSICU increased by 33.4% while LOS decreased by 3.5%. There was a decrease in neurosciences mortality (35.8%), catheter-associated urinary tract infection (50%), central line associated bloodstream infection (100%), and ventilator-associated pneumonia (50%). During the same time, patient satisfaction increased by 28.3% on physicians/nurses consistency (p = 0.025), by 69.5% in confidence/trust in physicians (p < 0.0001), by 78.3% on physicians treated me with courtesy/respect (p < 0.0001), and by 46.4% on physicians' attentiveness (p < 0.0001). Ultimately, patients recommending the hospital to others increased by 67.5% (p < 0.0001). ConclusionDedicated neurointensivists and the subsequent development of a neurocritical care team positively impacted quality outcome metrics, particularly significantly improving patient satisfaction.

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“…Their role is important for the patient’s health and clinical outcomes [ 35 , 36 ]. Studies have shown that neurointensivists who manage NSICUs improve outcomes and documentation and shorten the length of stay of all neurocritically ill patients [ 37 – 41 ], including those suffering from ischemic stroke [ 41 – 46 ], subarachnoid hemorrhage [ 47 , 48 ], traumatic brain injury [ 49 , 50 ], intracerebral hemorrhage [ 51 ], and neuromuscular respiratory failure [ 52 ].…”

Section: Adaptive Immunity (Fig 3 )mentioning

confidence: 99%

Immunosenescence in neurocritical care

2018

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BackgroundSeveral advanced and developing countries are now entering a superaged society, in which the percentage of elderly people exceeds 20% of the total population. In such an aging society, the number of age-related diseases such as malignant tumors, diabetes, and severe infections including sepsis is increasing, and patients with such disorders often find themselves in the ICU.Main bodyAge-related diseases are closely related to age-induced immune dysfunction, by which reductions in the efficiency and specificity of the immune system are collectively termed “immunosenescence.” The most noticeable is a decline in the antigen-specific acquired immune response. The exhaustion of T cells in elderly sepsis is related to an increase in nosocomial infections after septicemia, and even death over subacute periods. Another characteristic is that senescent cells that accumulate in body tissues over time cause chronic inflammation through the secretion of proinflammatory cytokines, termed senescence-associated secretory phenotype. Chronic inflammation associated with aging has been called “inflammaging,” and similar age-related diseases are becoming an urgent social problem.ConclusionIn neuro ICUs, several neuro-related diseases including stroke and sepsis-associated encephalopathy are related to immunosenescence and neuroinflammation in the elderly. Several advanced countries with superaged societies face the new challenge of improving the long-term prognosis of neurocritical patients.

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The Effect of a Neurocritical Care Service without a Dedicated Neuro-ICU on Quality of Care in Intracerebral Hemorrhage

Abstract: Introduction of a neurocritical service without a neuro-ICU at our institution was associated with a trend toward longer ICU LOS and improvement in some key metrics of quality of care for patients with ICH.

Cited by 26 publications

References 25 publications

Neurocritical care update

Neurocritical care update

Improvement in Quality Metrics Outcomes and Patient and Family Satisfaction in a Neurosciences Intensive Care Unit after Creation of a Dedicated Neurocritical Care Team

Immunosenescence in neurocritical care

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