Subarachnoid Hemorrhage 'Fast Track': A Health Economics and Health Care Redesign Approach for Early Selected Hospital Discharge
| Autor: | Tasneem F. Hasan, Robert S. Kaplan, Jessica L. Talbot, Lesia Mooney, Meredith Karney, Benjamin L. Thiemann, Stephanie L. Bonnett, Lisa Nordan, Katherine F. Nelson, William D. Freeman, Rabih G. Tawk, MaryAnn Ohanian, Christina I. Collins, Amanda L. Fouraker, David O. Hodge |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Subarachnoid hemorrhage 030204 cardiovascular system & hematology mFS modified Fisher scale law.invention 03 medical and health sciences 0302 clinical medicine law Medicine 030212 general & internal medicine Early discharge Stroke lcsh:R5-920 QI quality improvement business.industry DCI delayed cerebral ischemia WFNS World Federation of Neurological Surgeons medicine.disease ICU intensive care unit TDABC time-driven activity-based cost Intensive care unit Transcranial Doppler TCD transcranial Doppler ultrasonography Emergency medicine Cohort Original Article MCA middle cerebral artery SAH subarachnoid hemorrhage Fast track lcsh:Medicine (General) business LOS length of stay Cohort study |
| Zdroj: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 4, Iss 3, Pp 238-248 (2020) |
| ISSN: | 2542-4548 |
| DOI: | 10.1016/j.mayocpiqo.2020.04.001 |
| Popis: | Objective To determine whether earlier hospital discharge is feasible and safe in selected patients with subarachnoid hemorrhage (SAH) using an outpatient “fast-track” protocol. Patients and Methods We conducted a prospective quality improvement cohort study with the primary feasibility end point of patients with SAH deemed safe for discharge by treating team consensus. All patients received detailed education and outpatient transcranial Doppler monitoring; caregivers could contact the on-call team 24-7. Primary safety end points were adverse events after discharge and hospital readmission. Results From January 1, 2010, to January 1, 2015, our center had 377 SAH diagnoses, of which 200 were included in the final cohort, 36 qualifying for fast-track early discharge. The 30-day readmission rate for fast-track patients was 11.0% (4 of 36) compared with 11.4% (18 of 164) for non–fast-track patients. The rate of delayed cerebral ischemia and stroke was 3% (1 of 36) in the fast-track group vs 25.0% (41 of 164) for the non–fast-track group. Adverse events occurred in 11.0% (4 of 36) of the fast-track group compared with 26.0% (43 of 164) in the non–fast-track group. The mean length of stay was reduced 60% from 15 days to 6.6 days in the fast-track group. Conclusion Although our fast-track group was relatively small, data suggested early feasibility and safety in a carefully selected group of patients with SAH. Direct and indirect financial benefits of early discharge over a 5-year period were an estimated savings at least $864,000 in overall costs. A comparative effectiveness study is planned to replicate and validate these results using a larger multicenter design. |
| Databáze: | OpenAIRE |
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