Skip to main content Accessibility help
×
Home

The Operational and Economic Impact of a Neurovascular Unit in an Acute Care Academic Hospital

  • Eva Appel (a1), Shoshana Hahn-Goldberg (a1), Eric Chow (a2), Leanne K. Casaubon (a3) (a4) and Howard B. Abrams (a1) (a3) (a4)...

Abstract

Background: There is strong evidence that clinical outcomes are improved for stroke patients admitted to specialized Stroke Units. The Toronto Western Hospital (TWH) created a Neurovascular Unit (NVU) using resources from General Internal Medicine, Neurology, and Neurosurgery for patients with stroke and acute neurovascular conditions. Under resource-constrained conditions, the operational and economic impacts of the Neurovascular Unit were unknown. Methods: Retrospective patient-level data was studied from two years prior and one year post NVU implementation. Descriptive statistical analysis and non-parametric testing were conducted on the acute length of stay (LOS), alternate level of care LOS, total cost per bed-day and per visit, and patient flow within each medical service and hospital wide. Results: The median acute LOS per hospitalization for NVU-eligible patients decreased significantly (p=0.001). For Neurology patients, mean acute LOS decreased from 9.1 days pre-Neurovascular Unit to 7.6 days post and median acute LOS decreased from 6 to 5 days (p=0.002); however, mean alternate level of care LOS per visit more than doubled (from 1.6 to 4.1 days, p=0.001). For the Neurology service, the mean cost per visit decreased by $945, representing a 5% reduction (p=0.042) and the mean cost per bed-day decreased by $233, or 12.5% (p=0.026). Hospital wide, a saving of over C$450 000 was achieved. Conclusions : During the first year of operation, the NVU at TWH achieved decreased acute LOS per visit and lowered the total hospitalization cost per year for NVU-eligible patients. Addressing the issue of increased alternate level of care LOS could result in additional efficiencies.

L’impact opérationnel et économique d’une unité de soins neurovasculaires dans un hôpital universitaire de soins aigus. Contexte : Il existe des données importantes démontrant que les résultats cliniques sont améliorés chez les patients atteints d’un accident vasculaire cérébral (AVC) hospitalisés dans une unité de soins spécialisés dans le traitement de l’AVC. Le Toronto Western Hospital (TWH) a établi une unité de soins neurovasculaires (UNV) ayant recours aux ressources de la médecine interne générale, de la neurologie et de la neurochirurgie pour les patients atteints d’un AVC et de troubles neurovasculaires aigus. Dans un contexte de contraintes budgétaires, les impacts opérationnels et économiques de l’unité de soins neurovasculaires n’étaient pas connus. Méthode : Les données rétrospectives des patients ont été étudiées sur une période de 2 ans avant et de 1 an après la création de l’UNV. Nous avons effectué des analyses statistiques descriptives et des tests non paramétriques des données concernant la durée de séjour (DS) en soins aigus, la durée de séjour dans une unité d’un autre niveau de soins, le coût total par jour et par visite ainsi que l’aiguillage des patients dans chaque service médical et dans l’hôpital en général. Résultats : La DS médiane aiguë par hospitalisation pour les patients éligible à l’UNV a diminué significativement (p = 0,001). Pour les patients de neurologie, la DS moyenne en soins aigus a diminué et est passée de 9,1 jours avant la création de l’unité de soins neurovasculaires à 7,6 jours après sa création et la DS médiane en soins aigus a diminuée de 6 à 5 jours (p = 0,002). Cependant, la DS moyenne par visite dans une unité d’un autre niveau de soins a plus que doublé (de 1,6 jour à 4,1 jours, p = 0,001). Pour le service de neurologie, le coût moyen par visite a diminué de 945$, ce qui représente une diminution de 5% (p = 0,042) et le coût moyen par jour a diminué de 233$ soit une diminution de 12,5% (p = 0,026). Pour tout l’hôpital, ceci représente une épargne de 450 000$C. Conclusions : Au cours de la première année d’opération, l’UNV du TWH a réussi à diminuer la DS aiguë par visite et à diminuer le coût total d’hospitalisation par année pour les patients éligible à l’hospitalisation à l’UNV. Le fait d’examiner la question de la DS dans une unité de soins spécialisés est susceptible d’accroître l’efficience opérationnelle.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The Operational and Economic Impact of a Neurovascular Unit in an Acute Care Academic Hospital
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The Operational and Economic Impact of a Neurovascular Unit in an Acute Care Academic Hospital
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The Operational and Economic Impact of a Neurovascular Unit in an Acute Care Academic Hospital
      Available formats
      ×

Copyright

Corresponding author

Correspondence to: Eva Appel, University Health Network – Centre for Innovation in Complex Care, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada. E-mail: Eva.Appel@uhn.ca

References

Hide All
1. Fjaertoft, H, Rohweder, G, Indredavik, B. Stroke Unit Care Combined with Early Supported Discharge Improves 5-Year Outcome. Stroke. 2011;42:1707-1711.
2. Evans, A, Perez, I, Harraf, F, et al. Can Differences in Management Processes Explain Different Outcomes. Lancet. 2001;358:1586-1592.
3. Rotter, T, Kinsman, L, James, E, et al. The Effects of Clinical Pathways on Professional Practice, Patient Outcomes, Length of Stay, and Hospital Costs. Eval Health Prof. 2012;35:3-27.
4. Cereda, CW, Stadler, C, Andreotti, J, et al. Impact of Implementation of a New Semi-Intensive Stroke Unit versus a Mobile Stroke Team System – A Prospective Study within the Neurocentro of Southern Switzerland. Clin Neurophysiol. 2012;123:e101.
5. Stroke Unit Trialists’ Collaboration. Collaborative Systematic Review of the Randomized Trials of Organized Inpatient (Stroke Unit) Care after Stroke. BMJ. 1997;314:1151-1159.
6. Chen, LK, McClaran, J, Buchan, AM. Impact of Acute Stroke on Hospital Length of Stay. Arch Gerontol Geriatr. 2009;49.1:e12-e15.
7. Kapral, MK, Silver, FL, Hall, R, Stamplecoski, M, O’Callaghan, C, Tu, JV. Effect of a Provincial System of Stroke Care Delivery on Stroke Care Outcomes. CMAJ. 2013;185:e483-e491.
8. Addo, J, Crichton, S, Bhalla, A, Rudd, AG, Wolfe, CDA. Impact of Implementation of Evidence-Based Acute Stroke Interventions on Survival: The South London Stroke Register. PLoS. 2013;8:e61581.
9. Lahr, M, Luijckx, GJ, Vroomen, P, van der Zee, DJ, Buskens, E. Proportion of Patients Treated with Thrombolysis in a Centralized versus Decentralized Acute Stroke Care Setting. Stroke. 2012;43:1336-1340.
10. Hoffman, A, Wurie, F, Grant, R, Lowe, D, Rudd, A. National sentinel stroke audit phase 2 (clinical audit) 2008. Royal College of Physicians of London. 2009:17-33.
11. Canadian Stroke Network. A Guide to the Implementation of Stroke Unit Care. The Canadian Stroke Strategy; 2009.
12. National Collaborating Centre for Chronic Conditions. Stroke Guideline for Diagnosis and Management of Acute Stroke and TIA. Royal College of Physicians; 2012.
13. Intercollegiate Stroke Working Party. National clinical guideline for stroke, 4th edition. London: Royal College of Physicians; 2012.
14. Jauch, EC, Saver, JL, Adams, HP, et al. Guidelines for the Early Management of Patients with Acute Ischemic Stroke. Stroke. 2013;44:870-947.
15. Implementing Stroke and Orthopaedic Best Practices in the Toronto Central LHIN: Analysis of System Wide Impacts. Hay Group. March 31, 2012.

Keywords

Related content

Powered by UNSILO

The Operational and Economic Impact of a Neurovascular Unit in an Acute Care Academic Hospital

  • Eva Appel (a1), Shoshana Hahn-Goldberg (a1), Eric Chow (a2), Leanne K. Casaubon (a3) (a4) and Howard B. Abrams (a1) (a3) (a4)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.