Subarachnoid Hemorrhage “Fast Track”: A Health Economics and Health Care Redesign Approach for Early Selected Hospital Discharge
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...
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2020-06-01
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doaj-a55cbdd768d7490ba4f26bb0d0517b812020-11-25T03:29:46ZengElsevierMayo Clinic Proceedings: Innovations, Quality & Outcomes2542-45482020-06-0143238248Subarachnoid Hemorrhage “Fast Track”: A Health Economics and Health Care Redesign Approach for Early Selected Hospital DischargeChristina I. Collins, DNP, APRN0Tasneem F. Hasan, MD, MPH, CPH1Lesia H. Mooney, MSN, RN, ACNS BC2Jessica L. Talbot, RN, BSN3Amanda L. Fouraker, RN, BSN4Katherine F. Nelson, MSN, RN5MaryAnn Ohanian, RVT, RDMS6Stephanie L. Bonnett, RVT, RDMS7Rabih G. Tawk, MD8Lisa M. Nordan, MBIS9David O. Hodge, MS10Robert S. Kaplan, PhD11Benjamin L. Thiemann, BS12Meredith Karney, MHA13William D. Freeman, MD14Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL; Correspondence: Address to Christina I. Collins, DNP, APRN, Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224.Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FLDepartment of Nursing, Mayo Clinic, Jacksonville, FLDepartment of Neurology, Mayo Clinic, Jacksonville, FLDepartment of Neurology, Mayo Clinic, Jacksonville, FLDepartment of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, FLDepartment of Radiology, Mayo Clinic, Jacksonville, FLDepartment of Radiology, Ultrasound, Mayo Clinic, Jacksonville, FLDepartment of Neurologic Surgery, Mayo Clinic, Jacksonville, FLRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FLDivision of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FLAccounting and Management, Harvard Business School, Boston, MADepartment of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FLCenter for Medical Interoperability, Nashville, TNDepartment of Neurologic Surgery, Mayo Clinic, Jacksonville, FL; Department of Neurology, Mayo Clinic, Jacksonville, FL; Department of Critical Care and Multidisciplinary Program, Mayo Clinic, Jacksonville, FLObjective: 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.http://www.sciencedirect.com/science/article/pii/S2542454820300655 |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Christina I. Collins, DNP, APRN Tasneem F. Hasan, MD, MPH, CPH Lesia H. Mooney, MSN, RN, ACNS BC Jessica L. Talbot, RN, BSN Amanda L. Fouraker, RN, BSN Katherine F. Nelson, MSN, RN MaryAnn Ohanian, RVT, RDMS Stephanie L. Bonnett, RVT, RDMS Rabih G. Tawk, MD Lisa M. Nordan, MBIS David O. Hodge, MS Robert S. Kaplan, PhD Benjamin L. Thiemann, BS Meredith Karney, MHA William D. Freeman, MD |
spellingShingle |
Christina I. Collins, DNP, APRN Tasneem F. Hasan, MD, MPH, CPH Lesia H. Mooney, MSN, RN, ACNS BC Jessica L. Talbot, RN, BSN Amanda L. Fouraker, RN, BSN Katherine F. Nelson, MSN, RN MaryAnn Ohanian, RVT, RDMS Stephanie L. Bonnett, RVT, RDMS Rabih G. Tawk, MD Lisa M. Nordan, MBIS David O. Hodge, MS Robert S. Kaplan, PhD Benjamin L. Thiemann, BS Meredith Karney, MHA William D. Freeman, MD Subarachnoid Hemorrhage “Fast Track”: A Health Economics and Health Care Redesign Approach for Early Selected Hospital Discharge Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
author_facet |
Christina I. Collins, DNP, APRN Tasneem F. Hasan, MD, MPH, CPH Lesia H. Mooney, MSN, RN, ACNS BC Jessica L. Talbot, RN, BSN Amanda L. Fouraker, RN, BSN Katherine F. Nelson, MSN, RN MaryAnn Ohanian, RVT, RDMS Stephanie L. Bonnett, RVT, RDMS Rabih G. Tawk, MD Lisa M. Nordan, MBIS David O. Hodge, MS Robert S. Kaplan, PhD Benjamin L. Thiemann, BS Meredith Karney, MHA William D. Freeman, MD |
author_sort |
Christina I. Collins, DNP, APRN |
title |
Subarachnoid Hemorrhage “Fast Track”: A Health Economics and Health Care Redesign Approach for Early Selected Hospital Discharge |
title_short |
Subarachnoid Hemorrhage “Fast Track”: A Health Economics and Health Care Redesign Approach for Early Selected Hospital Discharge |
title_full |
Subarachnoid Hemorrhage “Fast Track”: A Health Economics and Health Care Redesign Approach for Early Selected Hospital Discharge |
title_fullStr |
Subarachnoid Hemorrhage “Fast Track”: A Health Economics and Health Care Redesign Approach for Early Selected Hospital Discharge |
title_full_unstemmed |
Subarachnoid Hemorrhage “Fast Track”: A Health Economics and Health Care Redesign Approach for Early Selected Hospital Discharge |
title_sort |
subarachnoid hemorrhage “fast track”: a health economics and health care redesign approach for early selected hospital discharge |
publisher |
Elsevier |
series |
Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
issn |
2542-4548 |
publishDate |
2020-06-01 |
description |
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. |
url |
http://www.sciencedirect.com/science/article/pii/S2542454820300655 |
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