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Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings

Identifieur interne : 000A13 ( Pmc/Checkpoint ); précédent : 000A12; suivant : 000A14

Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings

Auteurs : Anne W. Alexandrov ; Kisha C. Coleman ; Paola Palazzo ; Reza Bavarsad Shahripour ; Andrei V. Alexandrov

Source :

Therapeutic Advances in Neurological Disorders [ 1756-2856 ] ; 2016.

RBID : PMC:4916527

Abstract

Background:

In the USA, stable intravenous tissue plasminogen activator (IV tPA) patients have traditionally been cared for in an intensive care unit (ICU). We examined the safety of using an acuity-adaptable stroke unit (SU) to manage IV tPA patients.

Methods:

We conducted an observational study of consecutive patients admitted to our acuity-adaptable SU over the first 3 years of operation. Safety was assessed by symptomatic intracerebral hemorrhage (sICH) rates, systemic hemorrhage (SH) rates, tPA-related deaths, and transfers from SU to ICU; cost savings and length of stay (LOS) were determined.

Results:

We admitted 333 IV tPA patients, of which 302 were admitted directly to the SU. A total of 31 (10%) patients had concurrent systemic hemodynamic or pulmonary compromise warranting direct ICU admission. There were no differences in admission National Institutes of Health Stroke Scale scores between SU and ICU patients (9.0 versus 9.5, respectively). Overall sICH rate was 3.3% (n = 10) and SH rate was 2.9 (n = 9), with no difference between SU and ICU patients. No tPA-related deaths occurred, and no SU patients required transfer to the ICU. Estimated hospital cost savings were US$362,400 for ‘avoided’ ICU days, and hospital LOS decreased significantly (p = 0.001) from 9.8 ± 15.6 days (median 5) in year 1, to 5.2 ± 4.8 days (median 3) by year 3.

Conclusions:

IV tPA patients may be safely cared for in a SU when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for monitoring may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916527

DOI: 10.1177/1756285616648061
PubMed: 27366237
PubMed Central: 4916527

Affiliations:

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PMC:4916527

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<author><name sortKey="Alexandrov, Anne W" sort="Alexandrov, Anne W" uniqKey="Alexandrov A" first="Anne W." last="Alexandrov">Anne W. Alexandrov</name>
</author>
<author><name sortKey="Coleman, Kisha C" sort="Coleman, Kisha C" uniqKey="Coleman K" first="Kisha C." last="Coleman">Kisha C. Coleman</name>
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<author><name sortKey="Palazzo, Paola" sort="Palazzo, Paola" uniqKey="Palazzo P" first="Paola" last="Palazzo">Paola Palazzo</name>
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<author><name sortKey="Shahripour, Reza Bavarsad" sort="Shahripour, Reza Bavarsad" uniqKey="Shahripour R" first="Reza Bavarsad" last="Shahripour">Reza Bavarsad Shahripour</name>
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<author><name sortKey="Palazzo, Paola" sort="Palazzo, Paola" uniqKey="Palazzo P" first="Paola" last="Palazzo">Paola Palazzo</name>
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<author><name sortKey="Shahripour, Reza Bavarsad" sort="Shahripour, Reza Bavarsad" uniqKey="Shahripour R" first="Reza Bavarsad" last="Shahripour">Reza Bavarsad Shahripour</name>
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<series><title level="j">Therapeutic Advances in Neurological Disorders</title>
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<front><div type="abstract" xml:lang="en"><sec id="section1-1756285616648061"><title>Background:</title>
<p>In the USA, stable intravenous tissue plasminogen activator (IV tPA) patients have traditionally been cared for in an intensive care unit (ICU). We examined the safety of using an acuity-adaptable stroke unit (SU) to manage IV tPA patients.</p>
</sec>
<sec id="section2-1756285616648061"><title>Methods:</title>
<p>We conducted an observational study of consecutive patients admitted to our acuity-adaptable SU over the first 3 years of operation. Safety was assessed by symptomatic intracerebral hemorrhage (sICH) rates, systemic hemorrhage (SH) rates, tPA-related deaths, and transfers from SU to ICU; cost savings and length of stay (LOS) were determined.</p>
</sec>
<sec id="section3-1756285616648061"><title>Results:</title>
<p>We admitted 333 IV tPA patients, of which 302 were admitted directly to the SU. A total of 31 (10%) patients had concurrent systemic hemodynamic or pulmonary compromise warranting direct ICU admission. There were no differences in admission National Institutes of Health Stroke Scale scores between SU and ICU patients (9.0 <italic>versus</italic>
 9.5, respectively). Overall sICH rate was 3.3% (<italic>n</italic>
 = 10) and SH rate was 2.9 (<italic>n</italic>
 = 9), with no difference between SU and ICU patients. No tPA-related deaths occurred, and no SU patients required transfer to the ICU. Estimated hospital cost savings were US$362,400 for ‘avoided’ ICU days, and hospital LOS decreased significantly (<italic>p</italic>
 = 0.001) from 9.8 ± 15.6 days (median 5) in year 1, to 5.2 ± 4.8 days (median 3) by year 3.</p>
</sec>
<sec id="section4-1756285616648061"><title>Conclusions:</title>
<p>IV tPA patients may be safely cared for in a SU when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for monitoring may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
  <front><journal-meta><journal-id journal-id-type="nlm-ta">Ther Adv Neurol Disord</journal-id>
<journal-id journal-id-type="iso-abbrev">Ther Adv Neurol Disord</journal-id>
<journal-id journal-id-type="publisher-id">TAN</journal-id>
<journal-id journal-id-type="hwp">sptan</journal-id>
<journal-title-group><journal-title>Therapeutic Advances in Neurological Disorders</journal-title>
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<issn pub-type="ppub">1756-2856</issn>
<issn pub-type="epub">1756-2864</issn>
<publisher><publisher-name>SAGE Publications</publisher-name>
<publisher-loc>Sage UK: London, England</publisher-loc>
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<article-meta><article-id pub-id-type="pmid">27366237</article-id>
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<article-id pub-id-type="publisher-id">10.1177_1756285616648061</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject>
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</article-categories>
<title-group><article-title>Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Alexandrov</surname>
<given-names>Anne W.</given-names>
</name>
<xref ref-type="corresp" rid="corresp1-1756285616648061"></xref>
<aff id="aff1-1756285616648061">Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center & Australian Catholic University, Sydney, Australia. Address: UTHSC CON 920 Madison, Suite 532, Memphis, TN 38163, USA</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Coleman</surname>
<given-names>Kisha C.</given-names>
</name>
<aff id="aff2-1756285616648061">Blue Cross/Blue Shield of Alabama, Birmingham, Alabama</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Palazzo</surname>
<given-names>Paola</given-names>
</name>
<aff id="aff3-1756285616648061">Department of Neurology, Poitiers University Hospital, Poitiers, France</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Shahripour</surname>
<given-names>Reza Bavarsad</given-names>
</name>
<aff id="aff4-1756285616648061">Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center, Memphis, TN, USA</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Alexandrov</surname>
<given-names>Andrei V.</given-names>
</name>
<aff id="aff5-1756285616648061">Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center, Memphis, TN, USA</aff>
</contrib>
</contrib-group>
<author-notes><corresp id="corresp1-1756285616648061"><email>Anne@outcomesmgmt.org</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>15</day>
<month>5</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="ppub"><month>7</month>
<year>2016</year>
</pub-date>
<volume>9</volume>
<issue>4</issue>
<fpage>304</fpage>
<lpage>309</lpage>
<permissions><copyright-statement>© The Author(s), 2016</copyright-statement>
<copyright-year>2016</copyright-year>
<copyright-holder content-type="sage">SAGE Publications</copyright-holder>
</permissions>
<abstract><sec id="section1-1756285616648061"><title>Background:</title>
<p>In the USA, stable intravenous tissue plasminogen activator (IV tPA) patients have traditionally been cared for in an intensive care unit (ICU). We examined the safety of using an acuity-adaptable stroke unit (SU) to manage IV tPA patients.</p>
</sec>
<sec id="section2-1756285616648061"><title>Methods:</title>
<p>We conducted an observational study of consecutive patients admitted to our acuity-adaptable SU over the first 3 years of operation. Safety was assessed by symptomatic intracerebral hemorrhage (sICH) rates, systemic hemorrhage (SH) rates, tPA-related deaths, and transfers from SU to ICU; cost savings and length of stay (LOS) were determined.</p>
</sec>
<sec id="section3-1756285616648061"><title>Results:</title>
<p>We admitted 333 IV tPA patients, of which 302 were admitted directly to the SU. A total of 31 (10%) patients had concurrent systemic hemodynamic or pulmonary compromise warranting direct ICU admission. There were no differences in admission National Institutes of Health Stroke Scale scores between SU and ICU patients (9.0 <italic>versus</italic>
 9.5, respectively). Overall sICH rate was 3.3% (<italic>n</italic>
 = 10) and SH rate was 2.9 (<italic>n</italic>
 = 9), with no difference between SU and ICU patients. No tPA-related deaths occurred, and no SU patients required transfer to the ICU. Estimated hospital cost savings were US$362,400 for ‘avoided’ ICU days, and hospital LOS decreased significantly (<italic>p</italic>
 = 0.001) from 9.8 ± 15.6 days (median 5) in year 1, to 5.2 ± 4.8 days (median 3) by year 3.</p>
</sec>
<sec id="section4-1756285616648061"><title>Conclusions:</title>
<p>IV tPA patients may be safely cared for in a SU when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for monitoring may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit.</p>
</sec>
</abstract>
<kwd-group><kwd>stroke units</kwd>
<kwd>safety</kwd>
<kwd>functional outcome</kwd>
<kwd>cost savings</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
<affiliations><list></list>
<tree><noCountry><name sortKey="Alexandrov, Andrei V" sort="Alexandrov, Andrei V" uniqKey="Alexandrov A" first="Andrei V." last="Alexandrov">Andrei V. Alexandrov</name>
<name sortKey="Alexandrov, Anne W" sort="Alexandrov, Anne W" uniqKey="Alexandrov A" first="Anne W." last="Alexandrov">Anne W. Alexandrov</name>
<name sortKey="Coleman, Kisha C" sort="Coleman, Kisha C" uniqKey="Coleman K" first="Kisha C." last="Coleman">Kisha C. Coleman</name>
<name sortKey="Palazzo, Paola" sort="Palazzo, Paola" uniqKey="Palazzo P" first="Paola" last="Palazzo">Paola Palazzo</name>
<name sortKey="Shahripour, Reza Bavarsad" sort="Shahripour, Reza Bavarsad" uniqKey="Shahripour R" first="Reza Bavarsad" last="Shahripour">Reza Bavarsad Shahripour</name>
</noCountry>
</tree>
</affiliations>
</record>

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Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings

Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings

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Abstract

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