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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >The Operational and Economic Impact of a Neurovascular Unit in an Acute Care Academic Hospital
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The Operational and Economic Impact of a Neurovascular Unit in an Acute Care Academic Hospital

机译：急性护理学术医院神经血管单位的运营和经济影响

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Background: There is strong evidence that clinical outcomes are improved for stroke patients admitted to specialized Stroke Units. The Toronto Western Hospital (TWH) created a Neurovascular Unit (NVU) using resources from General Internal Medicine, Neurology, and Neurosurgery for patients with stroke and acute neurovascular conditions. Under resource-constrained conditions, the operational and economic impacts of the Neurovascular Unit were unknown. Methods: Retrospective patient-level data was studied from two years prior and one year post NVU implementation. Descriptive statistical analysis and non-parametric testing were conducted on the acute length of stay (LOS), alternate level of care LOS, total cost per bed-day and per visit, and patient flow within each medical service and hospital wide. Results: The median acute LOS per hospitalization for NVU-eligible patients decreased significantly (p=0.001). For Neurology patients, mean acute LOS decreased from 9.1 days pre-Neurovascular Unit to 7.6 days post and median acute LOS decreased from 6 to 5 days (p=0.002); however, mean alternate level of care LOS per visit more than doubled (from 1.6 to 4.1 days, p=0.001). For the Neurology service, the mean cost per visit decreased by $945, representing a 5% reduction (p=0.042) and the mean cost per bed-day decreased by $233, or 12.5% (p=0.026). Hospital wide, a saving of over C$450 000 was achieved. Conclusions: During the first year of operation, the NVU at TWH achieved decreased acute LOS per visit and lowered the total hospitalization cost per year for NVU-eligible patients. Addressing the issue of increased alternate level of care LOS could result in additional efficiencies.
机译：背景：有充分的证据表明，接受特殊卒中治疗的卒中患者的临床结局得到改善。多伦多西部医院（TWH）使用来自普通内科，神经病学和神经外科的资源为患有中风和急性神经血管疾病的患者创建了神经血管病科（NVU）。在资源有限的情况下，神经血管部门的运营和经济影响尚不清楚。方法：回顾性分析了NVU实施前两年和实施后一年的患者水平数据。描述性统计分析和非参数测试是针对急性住院时间（LOS），替代性服务水平LOS，每床日和每次就诊的总费用以及每种医疗服务和医院范围内的患者流量进行的。结果：符合NVU资格的患者每次住院的平均急性LOS降低（p = 0.001）。对于神经病学患者，平均急性LOS从神经血管单位治疗前的9.1天降低至术后7.6天，中位急性LOS从6天降低至5天（p = 0.002）;但是，平均每次就诊LOS替代水平增加了一倍以上（从1.6天到4.1天，p = 0.001）。对于神经病学服务，每次就诊的平均费用减少了945美元，减少了5％（p = 0.042），每张床日的平均费用减少了233美元或12.5％（p = 0.026）。整个医院节省了超过45万加元。结论：在手术的第一年，TWH的NVU降低了每次就诊的急性LOS，并降低了符合NVU资格的患者每年的总住院费用。解决替代服务水平增加的问题，LOS可能会提高效率。

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