Reporting on Neurological Decline as Identified by Hourly Neuroassessments

Area of Science:

• Neurology
• Critical Care Medicine
• Nursing Practice

Background:

• Hourly neurological examinations are a standard practice for monitoring neurological status in intensive care units.
• Limited data exist to support the efficacy and utility of frequent neurological assessments.
• The study addresses the need for evidence-based evaluation of this common clinical practice.

Purpose of the Study:

• To determine the frequency of neurological decline in patients receiving hourly neurological exams.
• To assess whether detected neurological decline was identified during scheduled assessments.
• To evaluate if identified neurological decline led to changes in patient management.

Main Methods:

• A cross-sectional survey was conducted in a neurological intensive care unit.
• Clinical neuroscience nurses completed surveys at the end of 12-hour shifts.
• Data were collected over 212 nurse shifts, focusing on hourly neurological assessments.

Main Results:

• Neurological changes were identified in 14% of observed shifts.
• Scheduled neurological exams detected changes more frequently than other times (P < .05).
• In 55% of cases with neurological decline, there was no alteration in the care plan; subarachnoid hemorrhage patients were more likely to have decline detected.

Conclusions:

• Many patients undergoing hourly neurological exams do not experience detectable neurological deterioration.
• Identified neurological decline frequently did not result in changes to the treatment plan.
• The yield of hourly neurological exams may vary by primary diagnosis, suggesting a need for tailored approaches and further research.