Neurosurgical admissions to the intensive care unit: intensive monitoring versus intensive therapy

Among 624 consecutive admissions to a medical-surgical intensive care unit (ICU), we identified 289 patients admitted for concentrated nursing care and intensive monitoring of whom only 44 (15%) received active treatment before discharge. Within this group were 82 patients admitted after uncomplicated elective neurosurgery. Only 1 of these patients required active treatment before discharge. None had any major physiological abnormality detected by electronic monitoring, and no patient required readmission to the ICU or died during hospitalization. These 82 neurosurgical admissions accounted for 13% of the total admissions over the study period and 10.5% of the total number of ICU days. The admission of these patients to the ICU was prompted by the need for labor-intensive services, such as hourly neurological checks, that were not available on the regular hospital floor. For stable postoperative neurosurgical patients, improved staffing of hospital wards could lead to a reduction in the number of admissions to the ICU.