Safety and Feasibility of a Fast-Track Pathway for Neurosurgical Craniotomy Patients: Bypassing the Intensive Care Unit.

Autor:	Perez-Vega C; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL., Sanghavi DK; Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL., Moreno Franco P; Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL., Chadha RM; Department of Anesthesiology, Mayo Clinic, Jacksonville, FL., Ardon AE; Department of Anesthesiology, Mayo Clinic, Jacksonville, FL., Bojaxhi E; Department of Anesthesiology, Mayo Clinic, Jacksonville, FL., Torp KD; Department of Anesthesiology, Mayo Clinic, Jacksonville, FL., Marshall LA; Department of Nursing, Mayo Clinic, Jacksonville, FL., Halstead TM; Department of Nursing, Mayo Clinic, Jacksonville, FL., Ford VE; Department of Nursing, Mayo Clinic, Jacksonville, FL., Christel LM; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL., Grewal SS; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL., Chaichana KL; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL., Quinones-Hinojosa A; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL., Howard LW; Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL.; Department of Neurology, Mayo Clinic, Jacksonville, FL., Fox WC; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL., Freeman WD; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL.; Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL.; Department of Neurology, Mayo Clinic, Jacksonville, FL.
Jazyk:	angličtina
Zdroj:	Mayo Clinic proceedings. Innovations, quality & outcomes [Mayo Clin Proc Innov Qual Outcomes] 2023 Nov 15; Vol. 7 (6), pp. 534-543. Date of Electronic Publication: 2023 Nov 15 (Print Publication: 2023).
DOI:	10.1016/j.mayocpiqo.2023.09.002
Abstrakt:	Objective: To describe the safety and feasibility of a fast-track pathway for neurosurgical craniotomy patients receiving care in a neurosciences progressive care unit (NPCU). Patients and Methods: Traditionally, most craniotomy patients are admitted to the neurosciences intensive care unit (NSICU) for postoperative follow-up. Decreased availability of NSICU beds during the coronavirus disease-2019 delta surge led our team to establish a de-novo NPCU to preserve capacity for patients requiring high level of care and would bypass routine NSICU admissions. Patients were selected a priori by treating neurosurgeons on the basis of the potential need for high-level ICU services. After operation, selected patients were transferred to the postoperative care unit, where suitability for NPCU transfer was reassessed with checklist-criteria. This process was continued after the delta surge. Results: From July 1, 2021 to September 30, 2022, 57 patients followed the NPCU protocol. Thirty-four (59.6%) were women, and the mean age was 56 years. Fifty-seven craniotomies for 34 intra-axial and 23 extra-axial lesions were performed. After assessment and application of the checklist-criteria, 55 (96.5%) were transferred to NPCU, and only 2 (3.5%) were transferred to ICU. All 55 patients followed in NPCU had good safety outcomes without requiring NSICU transfer. This saved $143,000 and led to 55 additional ICU beds for emergent admissions. Conclusion: This fast-track craniotomy protocol provides early experience that a surgeon-selected group of patients may be suitably monitored outside the traditional NSICU. This system has the potential to reduce overall health care expenses, increase capacity for NSICU bed availability, and change the paradigm of NSICU admission. Competing Interests: The authors report no competing interests. (© 2023 The Authors.)
Databáze:	MEDLINE
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