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NeuroICU FastTrack: Rapid Disposition of Patients with Intracerebral Hemorrhage from the Emergency Department to

Nicolle W Davis¹, Jeannette M Hester², Brandon Allen³

¹Comprehensive Stroke Center, University of Florida Health Shands Hospital, Gainesville, FL, USA. wilsnm@shands.ufl.edu.

Neurocritical Care

|April 25, 2025

Insights

Implementing the NeuroICU FastTrack pathway significantly reduced emergency department length of stay for intracerebral hemorrhage patients, leading to decreased mortality rates.

Area of Science:

Neurology
Critical Care Medicine
Health Services Research

Background:

Prolonged emergency department length of stay (EDLOS) is linked to increased mortality in critically ill patients.
Intracerebral hemorrhage (ICH) patients experience worse outcomes with extended EDLOS.
Reducing EDLOS is crucial for improving patient outcomes.

Purpose of the Study:

To implement an expedited triage pathway for ICH patients.
To reduce EDLOS to under 3 hours.
To evaluate the impact on morbidity and mortality.

Main Methods:

Retrospective analysis of ICH patients from January 2022 to June 2023.
Utilized univariate and multivariate logistic regression.
Investigated the association of the NeuroICU FastTrack intervention with EDLOS and mortality.

Main Results:

EDLOS decreased significantly from 6.6 to 4 hours post-intervention (p < 0.001).
In-hospital mortality reduced from 22.9% to 9.3% (p = 0.006).
Morbidity (mRS 0-2) remained stable (23% pre-intervention vs. 28% post-intervention).

Conclusions:

Shorter EDLOS for ICH patients significantly decreases mortality.
The NeuroICU FastTrack pathway improves patient throughput and outcomes.
No significant difference in morbidity was observed in this population.

Read full analysis

Abstract

Background:

Emergency department length of stay (EDLOS) directly impacts outcomes of critically ill patients, with the risk of in-hospital mortality increasing by nearly 40% when an intensive care unit (ICU) bed is delayed beyond 4 h. Patients with intracerebral hemorrhage (ICH) suffer from worse functional outcomes and higher mortality when EDLOS exceeds 5 h, even for EDLOS exceeding just 1 h. Our goal was to implement an expedited triage pathway to reduce EDLOS of patients with ICH to less than 3 h and evaluate for downstream reduced morbidity and mortality.

Methods:

We conducted a retrospective analysis of patients with ICH evaluated in the emergency department (ED) at an academic comprehensive stroke center between January 1, 2022, and June 30, 2023. Univariate and multivariate logistic regression analyses were conducted to investigate the association between the NeuroICU FastTrack intervention with EDLOS less than 3 h and the rate of in-hospital mortality.

Results:

A total of 234 patients with ICH arrived to the ED and were admitted to the neuro-ICU. Post implementation, there was a statistically significant decrease in EDLOS from an average of 6.6 h to 4 h (p < 0.001) and a significant decrease in patient mortality (p = 0.006). There was also a reduction in mortality to 9.3% (p = 0.006) compared to a preintervention mortality rate of 22.9%. Additionally, the morbidity outcome (mRS of 0-2) remained relatively constant in both groups preintervention (23%) to post intervention (28%).

Conclusions:

Consistent with prior published evidence and National Institute of Neurological Disorders and Stroke recommendations, a shorter EDLOS significantly decreased mortality, but there was no difference in morbidity in our population. The NeuroICU FastTrack process expedited critically ill ICH patient throughput from the ED to the ICU, enhanced bed availability through streamlined procedures, and improved patient outcomes.

Keywords:

Emergency department Intracerebral hemorrhage Neurointensive care unit Stroke

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