TY - JOUR
T1 - Aneurysmal Subarachnoid Hemorrhage Mortality after Implementation of Nocturnist Advanced Practice Provider Coverage
AU - McLaughlin, DIane C.
AU - Margretta, Margaret M.
AU - Freeman, William D.
N1 - Publisher Copyright:
Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association of Neuroscience Nurses.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Introduction: We hypothesized that a nocturnist advanced practice provider (APP) model compared with overnight neurocritical care coverage with general critical care physicians and neurology residents would provide similar patient outcomes, as measured by patient mortality. Methods: This study is a retrospective review of healthcare outcomes of aneurysmal subarachnoid hemorrhage (aSAH) patients from 2013 and 2016, after implementation of specialty-trained neurocritical care nocturnist APPs. In 2013, overnight hours were covered by the general intensive care unit team and a junior neurology resident. In 2016, these patients were cared for by APPs overnight. The primary outcome measured was comparison of mortality before and after this change of overnight coverage because the daytime coverage remained similar between years. Results: In 2013, 58 patients were admitted to the neurocritical care unit with aSAH. In 2016, 19 aSAH patients were admitted to the neurocritical care unit. The mean modified Fisher grade was 3.36 in 2013, with 14 of 58 deaths (mortality rate, 24%). In 2016, the mean modified Fisher grade was 3.4. Three patients died (mortality rate, 15.7%). Conclusion: The active nocturnist APP model was associated with an approximately 10% reduction in SAH mortality (P =.54). This supports the hypothesis that APPs can provide noninferior care as the previous model. Further studies are needed to demonstrate the effects of both nocturnist and APP-driven models.
AB - Introduction: We hypothesized that a nocturnist advanced practice provider (APP) model compared with overnight neurocritical care coverage with general critical care physicians and neurology residents would provide similar patient outcomes, as measured by patient mortality. Methods: This study is a retrospective review of healthcare outcomes of aneurysmal subarachnoid hemorrhage (aSAH) patients from 2013 and 2016, after implementation of specialty-trained neurocritical care nocturnist APPs. In 2013, overnight hours were covered by the general intensive care unit team and a junior neurology resident. In 2016, these patients were cared for by APPs overnight. The primary outcome measured was comparison of mortality before and after this change of overnight coverage because the daytime coverage remained similar between years. Results: In 2013, 58 patients were admitted to the neurocritical care unit with aSAH. In 2016, 19 aSAH patients were admitted to the neurocritical care unit. The mean modified Fisher grade was 3.36 in 2013, with 14 of 58 deaths (mortality rate, 24%). In 2016, the mean modified Fisher grade was 3.4. Three patients died (mortality rate, 15.7%). Conclusion: The active nocturnist APP model was associated with an approximately 10% reduction in SAH mortality (P =.54). This supports the hypothesis that APPs can provide noninferior care as the previous model. Further studies are needed to demonstrate the effects of both nocturnist and APP-driven models.
KW - APP
KW - SAH
KW - advanced practice providers
KW - mortality
KW - neurocritical care
KW - subarachnoid hemorrhage
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U2 - 10.1097/JNN.0000000000000352
DO - 10.1097/JNN.0000000000000352
M3 - Article
C2 - 29521734
AN - SCOPUS:85044053265
SN - 0888-0395
VL - 50
SP - 102
EP - 104
JO - Journal of Neuroscience Nursing
JF - Journal of Neuroscience Nursing
IS - 2
ER -