naa a22 4500 510800092 CHVBK 20180411083351.0 cr unu---uuuuu 180411e20130601xx s 000 0 eng 10.1007/s12028-013-9818-1 doi (NATIONALLICENCE)springer-10.1007/s12028-013-9818-1 The Effect of a Neurocritical Care Service without a Dedicated Neuro-ICU on Quality of Care in Intracerebral Hemorrhage [Elektronische Daten] [Joseph Burns, Deborah Green, Helena Lau, Michael Winter, Feliks Koyfman, Christina DeFusco, James Holsapple, Carlos Kase] Background: Introduction of neurocritical care services to dedicated neuro-ICUs is associated with improved quality of care. The impact of a neurocritical care service without a dedicated neuro-ICU has not been studied. Methods: We retrospectively identified all patients admitted to our institution with intracerebral hemorrhage (ICH) in two 12-month periods: immediately before the arrival of the first neurointensivist ("before”) and after the neurocritical care service was established ("after”). There was no nursing team, ICU housestaff/physician extender team, or physical unit dedicated to the care of patients with critical neurologic illness during either period. Using an uncontrolled before-after design, we compared clinical outcomes and performance on quality metrics between groups. Results: We included 74 patients with primary supratentorial ICH. Mortality, length of stay (LOS), proportion of patients with modified Rankin Score 0-3, and destination on discharge did not differ between groups when adjusted for confounders. Time to first two consecutive systolic blood pressure (SBP) measurements <180mmHg was shorter in the "after” cohort (mean 4.5 vs. 3.2h, p=0.001). Area under the curve measurement for change in SBP from baseline over the first 24h after ED arrival demonstrated greater, sustained SBP reduction in the "after” cohort (mean −187.9 vs. −720.9, p=0.04). A higher proportion of patients were fed without passing a dysphagia screen in the "before” group (45 vs. 0%, p<0.001). Conclusions: Introduction of a neurocritical service without a neuro-ICU at our institution was associated with a trend toward longer ICU LOS and improvement in some key metrics of quality of care for patients with ICH. Springer Science+Business Media New York, 2013 Intracerebral hemorrhage nationallicence Neurocritical care nationallicence Quality nationallicence Blood pressure nationallicence Dysphagia nationallicence Length of stay nationallicence Burns Joseph Department of Neurology, Boston University School of Medicine, 72 East Concord Street, C-3, 02118, Boston, MA, USA aut Green Deborah Department of Neurology, Boston University School of Medicine, 72 East Concord Street, C-3, 02118, Boston, MA, USA aut Lau Helena Department of Neurology, Boston University School of Medicine, 72 East Concord Street, C-3, 02118, Boston, MA, USA aut Winter Michael Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA aut Koyfman Feliks Department of Neurosciences, Winthrop-University Hospital, Mineola, NY, USA aut DeFusco Christina Department of Neurology, Boston University School of Medicine, 72 East Concord Street, C-3, 02118, Boston, MA, USA aut Holsapple James Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA aut Kase Carlos Department of Neurology, Boston University School of Medicine, 72 East Concord Street, C-3, 02118, Boston, MA, USA aut Neurocritical Care Humana Press Inc 18/3(2013-06-01), 305-312 1541-6933 18:3<305 2013 18 12028 https://doi.org/10.1007/s12028-013-9818-1 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9818-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Burns Joseph Department of Neurology, Boston University School of Medicine, 72 East Concord Street, C-3, 02118, Boston, MA, USA aut NATIONALLICENCE 700 1- Green Deborah Department of Neurology, Boston University School of Medicine, 72 East Concord Street, C-3, 02118, Boston, MA, USA aut NATIONALLICENCE 700 1- Lau Helena Department of Neurology, Boston University School of Medicine, 72 East Concord Street, C-3, 02118, Boston, MA, USA aut NATIONALLICENCE 700 1- Winter Michael Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA aut NATIONALLICENCE 700 1- Koyfman Feliks Department of Neurosciences, Winthrop-University Hospital, Mineola, NY, USA aut NATIONALLICENCE 700 1- DeFusco Christina Department of Neurology, Boston University School of Medicine, 72 East Concord Street, C-3, 02118, Boston, MA, USA aut NATIONALLICENCE 700 1- Holsapple James Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA aut NATIONALLICENCE 700 1- Kase Carlos Department of Neurology, Boston University School of Medicine, 72 East Concord Street, C-3, 02118, Boston, MA, USA aut NATIONALLICENCE 773 0- Neurocritical Care Humana Press Inc 18/3(2013-06-01), 305-312 1541-6933 18:3<305 2013 18 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer