Introduction: Length of stay is often utilized to assess a Neurosurgery service’s efficiency, while patient volume and the number of discharges the Neurosurgery inpatient team coordinates is not taken into account. Additionally, lack of an adequate Neurosurgery inpatient bed supply and appropriate bed classification (acute/intermediate/critical care) is a common problem in Academic Medical Centers, furthering high volume patient and caregiver implications. Neurosurgery patients cared for on non-neurosurgery units creates a multitude of patient safety and care challenges. To create an environment of safety, the Neurosurgery service employs one nurse practitioner on acute care to evaluate, treat, and coordinate patient care in collaboration with the resident physicians, faculty, and the remainder of the health care team. The number of Neurosurgery discharges from July through November 2016 as compared to 2014 as well as the resultant increase in length of stay will be presented.

Methods: Total number of discharge data was retrospectively reviewed, collected 7/1-11/30/2012 and 7/1-11/30/2017 via monthly institutional abstraction. Length of stay data was collected in the same manner. Further individual data is sent via excel to the individual provider. Data is collected and distributed by the institutional electronic health record information technology team.

Results: The number of neurosurgery discharges increased from 628 to 763, an increase of 21.5% from 2012 to 2017 during the sample months of 7/1-11/30. Notably, Neurosurgery had the most discharges of any service at this Academic Medical Center. The length of stay increased from 5.1 days to 5.9 days. A 15.7% increase during the same time period.

Conclusions: A Neurosurgery service’s 21.5% volume increase correlated with a 15.7% increase in length of stay. The increase in length of stay is likely multifactorial. Contributing factors include the high increase in volume, fragmented care due to patient placement on non-neurosurgery units; resident physician and nurse practitioner patient care load; discharge planning system overload; patient complexity; and health care system strain. Increased length of stay further stresses the system with decreased patient throughput. Opportunities exist to further investigate the effect of volume on adverse events, patient experience, readmission rates, and health care system processes.

Patient Care: A positive patient experience, with positive outcomes is the goal of Neurosurgery providers. An appreciation of the potential impact of volume and length of stay will aid in planning and striving to avoid situations that may negatively impact the patient.

Learning Objectives: At the conclusion of this session, applicants should be able to: 1. Discuss the potential relationship between volume and length of stay. 2. Discuss the potential impact of high volume.

References: Davies, J.M., Ozpinar, A., & Lawton, M.T. (2015). Volume-Outcome relationships in neurosurgery. Neurosurgery Clinics of North America, 26: 207-218 Moghavem, N., McDonald, K., Ratliff, J., & Hernandez-Boussard, T. (2016). Performance measures in neurosurgical patient care: differing applications of patient safety indicators. Medical Care, 54: 359-364. Perotti, V. and Sheridan, M. M. P. (2015). Root cause analysis of critical events in neurosurgery, New South Wales. ANZ Journal of Surgery, 85: 626-630. Taylor, B.E.S., Youngerman, B.E., Goldstein, H., Kabat, D.H., Appelboom, G., Gold, W.E., & Connolly, E.S, Jr. (2016). Causes and timing of unplanned early readmission after neurosurgery. Neurosurgery, 79: 356-389.