Affiliation:
1. Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
2. Stanford University, Quantitative Sciences Unit, Stanford, CA, USA
3. Stanford Health Care, Stanford, CA, USA
Abstract
Background and Purpose The purpose is to determine the impact of an academic neurohospitalist service on clinical outcomes. Methods We performed a retrospective, quasi-experimental study of patients discharged from the general neurology service before (August 2010–July 2014) and after implementation of a full-time neurohospitalist service (August 2016–July 2018) compared to a control group of stroke patients. Primary outcomes were length of stay and 30-day readmission. Using the difference-in-difference approach, the impact of introducing a neurohospitalist service compared to controls was assessed with adjustment of patients’ characteristics. Secondary outcomes included mortality, in-hospital complications, and cost. Results There were 2706 neurology admissions (1648 general; 1058 stroke) over the study period. The neurohospitalist service was associated with a trend in reduced 30-day readmissions (ratio of ORs: .52 [.27, .98], P = .088), while length of stay was not incrementally changed in the difference-in-difference model (-.3 [-.7, .1], P = .18). However, descriptive results demonstrated a significant reduction in mean adjusted LOS of .7 days (4.5 to 3.8 days, P < .001) and a trend toward reduced readmissions (8.9% to 7.6%, P = .42) in the post-neurohospitalist cohort despite a significant increase in patient complexity, shift to higher acuity diagnoses, more emergent admissions, and near quadrupling of observation status patients. Mortality and in-hospital complications remained low, patient satisfaction was stable, and cost was not incrementally changed in the post-neurohospitalist cohort. Conclusions Implementation of a neurohospitalist service at an academic medical center is feasible and associated with a significant increase in patient complexity and acuity and a trend toward reduced readmissions.