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A step-down unit transfer protocol for low-risk aneurysmal subarachnoid hemorrhage.

Alexander G Chartrain1, Ahmed J Awad1, Christopher A Sarkiss1

  • 1Departments of 1 Neurosurgery and.

Neurosurgical Focus
|November 2, 2017
PubMed
Summary

A new protocol safely transfers select subarachnoid hemorrhage (SAH) patients to a step-down unit (SDU), reducing intensive care unit (ICU) length of stay without increasing readmissions. This streamlines care for SAH patients.

Keywords:
GCS = Glasgow Coma ScaleGOS = Glasgow Outcome ScaleICP = intracranial pressureLOS = length of stayNSICU = neurosurgical intensive care unitSAH = subarachnoid hemorrhageSDU = step-down unitTBI = traumatic brain injuryTCD = transcranial Doppleraneurysmal subarachnoid hemorrhagehigh-volume centerintensive care unitstep-down unittransfer protocol

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Area of Science:

  • Neurosurgery
  • Critical Care Medicine
  • Healthcare Management

Background:

  • Subarachnoid hemorrhage (SAH) patients often require intensive care unit (ICU) admission.
  • Not all SAH patients necessitate prolonged ICU stays.
  • Optimizing care pathways for SAH patients is crucial.

Purpose of the Study:

  • To evaluate the safety and efficacy of a protocol for transferring select low-risk SAH patients from the neurosurgical ICU (NSICU) to a step-down unit (SDU).
  • To assess the impact of the SDU transfer protocol on length of stay, patient outcomes, and readmission rates.

Main Methods:

  • Retrospective chart review of SAH patients admitted between January 2011 and September 2016.
  • Comparison of a control group (pre-protocol) with an intervention group (post-protocol implementation).
  • Analysis of transfer rates to SDU, return-to-ICU rates, morbidity, mortality, length of stay, and readmission rates.

Main Results:

  • 79.2% of eligible SAH patients were transferred to the SDU.
  • 29.8% of transferred patients required return to the NSICU, with no SDU-related morbidity or mortality.
  • A trend towards reduced NSICU length of stay (1.95 days) and longer overall hospitalization (2.7 days) was observed.
  • No significant differences in in-hospital mortality or 90-day readmission rates between groups.
  • Early transfer (prior to 7 days) did not increase return-to-NSICU or readmission rates.

Conclusions:

  • The SDU transfer protocol is safe, feasible, and effective in reducing NSICU length of stay for select SAH patients.
  • Transfer timing did not impact the rate of return to NSICU or 90-day readmission.
  • Further validation in large, multicenter studies is recommended.