Key result
The Safe Transitions Pathway for post-craniotomy patients reduced ICU days and costs, with a trend toward fewer 30-day readmissions compared to standard care (1.2% vs 5.1%, p=0.058).
Why the study?
Does a Safe Transitions Pathway bypassing the ICU improve clinical and financial outcomes in post-craniotomy patients?
Cohort
Does a Safe Transitions Pathway bypassing the ICU improve clinical and financial outcomes in post-craniotomy patients?
Absolute Event Rate: 1.2% vs 5.1%
p-value: p=0.058
A Safe Transitions Pathway bypassing the ICU for select post-craniotomy patients is safe and significantly reduces ICU utilization and hospital costs.
May support ICU bypass pathways in select post-craniotomy patients; leaves open efficacy and safety pending randomized confirmation.
OBJECTIVE: High-value medical care is described as care that leads to excellent patient outcomes, high patient satisfaction, and efficient costs. Neurosurgical care in particular can be expensive for the hospital, as substantial costs are accrued during the operation and throughout the postoperative stay. The authors developed a "Safe Transitions Pathway" (STP) model in which select patients went to the postanesthesia care unit (PACU) and then the neuro-transitional care unit (NTCU) rather than being directly admitted to the neurosciences intensive care unit (ICU) following a craniotomy. They sought to evaluate the clinical and financial outcomes as well as the impact on the patient experience for patients who participated in the STP and bypassed the ICU level of care. METHODS: Patients were enrolled during the 2018 fiscal year (FY18; July 1, 2017, through June 30, 2018). The electronic medical record was reviewed for clinical information and the hospital cost accounting record was reviewed for financial information. Nurses and patients were given a satisfaction survey to assess their respective impressions of the hospital stay and of the recovery pathway. RESULTS: No patients who proceeded to the NTCU postoperatively were upgraded to the ICU level of care postoperatively. There were no deaths in the STP group, and no patients required a return to the operating room during their hospitalization (95% CI 0%-3.9%). There was a trend toward fewer 30-day readmissions in the STP patients than in the standard pathway patients (1.2% [95% CI 0.0%-6.8%] vs 5.1% [95% CI 2.5%-9.1%], p = 0.058). The mean number of ICU days saved per case was 1.20. The average postprocedure length of stay was reduced by 0.25 days for STP patients. Actual FY18 direct cost savings from 94 patients who went through the STP was $422,128. CONCLUSIONS: Length of stay, direct cost per case, and ICU days were significantly less after the adoption of the STP, and ICU bed utilization was freed for acute admissions and transfers. There were no substantial complications or adverse patient outcomes in the STP group.
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Young et al. (2020) conducted a cohort in Post-craniotomy neurological surgery. Safe Transitions Pathway (STP) vs. Standard pathway was evaluated on 30-day readmissions (p=0.058). The Safe Transitions Pathway for post-craniotomy patients reduced ICU days and costs, with a trend toward fewer 30-day readmissions compared to standard care (1.2% vs 5.1%, p=0.058).
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