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Case management in cerebral revascularization
R M Hoyle1, J M Jenkins, W H Edwards
1Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
Insights
Case management and selective intensive care unit (ICU) use in cerebral revascularization improve patient outcomes and reduce costs. This approach enhances care quality and physician/nurse collaboration without increasing morbidity or mortality.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Healthcare Management
Background:
- Cerebral revascularization procedures carry inherent risks.
- Optimizing patient management and resource utilization is crucial for improving outcomes and reducing healthcare costs.
Purpose of the Study:
- To evaluate the clinical and financial outcomes of combining case management with selective intensive care unit (ICU) admission for cerebral revascularization.
- To assess the impact of this integrated approach on morbidity, mortality, length of stay, and costs.
Main Methods:
- Retrospective review of 384 procedures in 331 patients undergoing cerebral revascularization.
- Analysis of morbidity, mortality, hospital length of stay, cost, and readmissions.
- Examination of hypertension as a variable influencing patient outcomes.
Main Results:
- Cerebral revascularization procedures demonstrated low stroke (0.78%) and perioperative death (0.26%) rates.
- Selective ICU admission was required for 2.3% of patients due to instability and 0.78% for hemodynamic management.
- Case management reduced mean hospital stay by 2.1 days and decreased mean costs by $1987 (28.9% savings).
Conclusions:
- The combined strategy of case management and selective ICU use optimizes patient care and conserves financial resources.
- This approach does not adversely impact morbidity or mortality rates.
- Enhanced physician/nurse collaboration and improved patient satisfaction were observed.
Purpose:
We examined the clinical and financial outcomes of case management coupled with the initiation of selective use of the intensive care unit (ICU) in all cerebral revascularization procedures.
Methods:
Three hundred eighty-four procedures in 331 patients were retrospectively reviewed. Morbidity and mortality rates, hospital length of stay, cost, and ICU or hospital readmissions were examined. Hypertension was examined as an independent variable for its effect on patient outcome.
Results:
Cerebral revascularization, including carotid endarterectomy, vertebral-carotid artery transposition, and subclavian-carotid artery transposition, yielded a 0.78% stroke rate and 0.26% perioperative death rate in this series. ICU admission was necessary in nine patients (2.3%) for cardiac or respiratory instability. Three patients (0.78%) required transfer to the ICU for management of hypertension or hypotension. The mean hospital length of stay after institution of case management was reduced by 2.1 days, and the mean cost was decreased by $1987, a savings of 28.9% of total hospital cost.
Conclusion:
The dual approach of case management and selective use of the ICU promotes quality patient care, conserves financial resources without adversely affecting morbidity or mortality rates, enhances physician/nurse collaboration, and improves patient satisfaction.
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