Abstract 76: Expediting Intracerebral Hemorrhage Patients to the NeuroICU and Improving Emergency Department Length of Stay

Abstract

Introduction: Emergency Department Length of Stay (EDLOS) impacts outcomes of critically ill intracerebral hemorrhage (ICH) patients with the risk of dying while hospitalized increasing 40% when an intensive care unit (ICU) bed is delayed beyond 4h. The NINDS recommends admission to the destination unit within 3 hours of hospital arrival; however, EDLOS for ICH patients spans about 5 hours with a wide variation. To expedite patient admission, we developed a standardized triage pathway (NeuroICU-FastTrack). In this study, we evaluated whether NeuroICU-FastTrack decreased EDLOS and whether this decreased time reduced hospital length of stay or improved patient outcomes. Methods: ICH patients presenting to UFHealth Shands between 1/1/22-6/30/22 were evaluated to establish baseline EDLOS, length of hospitalization, and functional outcomes defined as modified Rankin Score (mRS). On 7/1/22 NeuroICU-FastTrack was implemented and patients admitted through 6/30/23 were evaluated to establish post-intervention characteristics. To avoid bias, data was extrapolated from medical records. Statistical analyses were performed on R (v4.3.1). Results: Compared to the pre-intervention group (n=48), the post-intervention group (n=129) had a significantly lower EDLOS (mean 7.3h vs 4.4h, p<0.001), but no difference in functional outcomes. During the intervention period, there was a trend toward decreasing EDLOS (F(1,126)=3.91, p=0.050) and a significant decrease in the length of hospitalization by two days (F(1,123)= 4.38, p=0.038). Based on correlation analysis, the success of the NeuroICU-FastTrack is due to expedited timing of the bed request order, allocation of a pre-assigned bed, and speed of the final bed assignment (Pearson’s r= 0.307, 0.493 and 0.645 respectively; p<0.001). Conclusion: There is an urgent need for expedited disposition of patients with ICH to an ICU due to significant variability in stroke care provided in an ED. The NeuroICU-FastTrack process significantly decreased the EDLOS from a median time of 6.2h to 2.8h. With this decreased EDLOS, there is an associated overall decreased hospital length of stay by two days. Additional studies are being conducted to evaluate whether our intervention impacted long-term functional outcomes.