Introduction:

Aneurysmal subarachnoid hemorrhage (aSAH) is associated with many factors that prolong length of stay (LOS) and total costs (TC). In this study, we propose an intervention that may result in decreased LOS and TC.

Methods:

345 SAH patients were reviewed over a three year period. Patient demographics, hospital course, TC, and LOS were reviewed. Non-aneurysmal SAH, Hunt-Hess (HH) grade 5, and early mortalities were excluded. During this period a daily physician-led multidisciplinary huddle was established to identify and implement discharge needs.

Results:

174 patients met inclusion criteria. Statistically significant predictors of increased LOS included higher HH grade (p<0.001), hydrocephalus (p<0.001), clinical vasospasm (p<0.001), need for ventriculoperitoneal shunt (p<0.001), deep venous thrombosis (p=0.026), and respiratory failure (p<0.001). Vasospasm, ventriculoperitoneal shunt, and respiratory failure remained significant on multivariate analysis. Mean hospital LOS decreased from 21.6 to 14.1 days; ICU LOS dropped from 16.0 to 12.4 days. Total costs per aSAH patient decreased from $328K to $269K. During this period, readmission rate and breakdown by patient discharge site remained unchanged.

Conclusions:

Application of a physician-led multidisciplinary huddle contributed to a significant decrease in LOS and TC in aSAH admissions. Other institutions are encouraged to implement similar initiatives to improve length of stay and reduce costs.

Patient Care:

Implementation of a multidisciplinary huddle in neurosurgery services across the country has the potential to decrease length of stay and cost in care of patients with aneurysmal subarachnoid hemorrhage. Efficient disposition helps patients avoid the dangers of an extended hospital stay, including infection and deep venous thrombosis.

Learning Objectives:

Hospital length of stay and total costs associated with care of patients with aneurysmal subarachnoid hemorrhage can be reduced through implementation of a mulidisciplinary huddle to identify and implement discharge needs.

References:

1. Hoh BL, Chi YY, Dermott MA, Lipori PJ, Lewis SB: The effect of coiling versus clipping of ruptured and unruptured cerebral aneurysms on length of stay, hospital cost, hospital reimbursement, and surgeon reimbursement at the university of Florida. Neurosurgery 64:614-619; discussion 619-621, 2009. 2. Suarez JI, Zaidat OO, Suri MF, Feen ES, Lynch G, Hickman J, et al: Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team. Crit Care Med 32:2311-2317, 2004.