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Serôdio M, Magriço M, Sobral-Pinho A, Ventura R, Serrazina F, Cabral G, Meira B, Fernandes M, Salavisa M, Saraiva M, Marto JP, Sá F, Calado S, Viana-Baptista M. The Role of Neurohospitalism in a Specialized Cardiovascular Hospital. Eur Neurol 2024; 87:49-53. [PMID: 38382475 DOI: 10.1159/000537930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Cardiology and cardiothoracic surgery are among the specialties that most commonly require neurology inpatient consultations. We aimed to study the neurology referrals by the cardiovascular-specialized hospital included in our tertiary hospital center. METHODS Retrospective study of consecutive patients referred for neurology inpatient consultation between January 1, 2020, and December 31, 2022. We analyzed referrals, patients' characteristics, and the approach taken. A detailed subanalysis was performed for patients diagnosed with acute ischemic stroke (AIS). RESULTS 143 patients were observed (mean age 67.3 years, 46 [32.2%] females). Most frequent referral reasons were suspected AIS deficits (39.2%), altered mental status (19.6%), suspected seizures (13.3%), and neuroprognostication (11.9%). Mean referral-to-consult time was 2.7 days, and 117 (81.8%) consults were in-person. Additional investigation, treatment changes, and outpatient clinic referral were proposed, respectively, in 79.7%, 60.1%, and 19.6% of patients. Most common diagnoses were AIS (45.5%), hypoxic-ischemic encephalopathy (18.9%), and delirium (7.0%). Regarding patients with AIS (n = 62), most common stroke causes were post-cardiac procedure (44.6%), infective endocarditis (18.5%), aortic dissection (10.8%), acute myocardial infarction (10.8%), and anticoagulant withdrawal in patients with atrial fibrillation (6.2%). Thirty-four AIS patients were diagnosed less than 24 h since last seen well, of which four (6.2%) were treated (three with thrombolysis and one with mechanical thrombectomy). CONCLUSION AIS is the most common reason for referral in our cardiovascular hospital. Our results highlight the importance of the availability of a neurologist/neurohospitalist with stroke expertise for consultation of inpatients admitted in a specialized cardiovascular hospital.
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Affiliation(s)
- Miguel Serôdio
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Marta Magriço
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - André Sobral-Pinho
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Rita Ventura
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Filipa Serrazina
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Gonçalo Cabral
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Bruna Meira
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Marco Fernandes
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Manuel Salavisa
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Marlene Saraiva
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- Chronic Diseases Research Centre (CEDOC), Faculdade de Ciências Médicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Francisca Sá
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Sofia Calado
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- Chronic Diseases Research Centre (CEDOC), Faculdade de Ciências Médicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
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Gold CA, Scott BJ, Weng Y, Bernier E, Kvam KA. Outcomes of a Neurohospitalist Program at an Academic Medical Center. Neurohospitalist 2022; 12:453-462. [DOI: 10.1177/19418744221083182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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.
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Affiliation(s)
- Carl A. Gold
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Brian J. Scott
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Yingjie Weng
- Stanford University, Quantitative Sciences Unit, Stanford, CA, USA
| | | | - Kathryn A. Kvam
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
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Probasco JC, Greene J, Harrison A, Jensen J, Khot S, Klein JP, Simpson J, Wold J, Josephson SA, Likosky D. Neurohospitalist Practice, Perspectives, and Burnout. Neurohospitalist 2019; 9:85-92. [PMID: 30915186 DOI: 10.1177/1941874418813029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose Neurohospitalist neurology is a fast-growing subspecialty with a variety of practice settings featuring neurohospitalist models of care. Since inception, the subspecialty has responded to new challenges in resident training, hospital reimbursement, practice, and burnout. Methods To characterize neurohospitalists' current practice and perspectives, we surveyed the neurohospitalists and trainees affiliated with the Neurohospitalist Society using an electronic survey distributed through the society listserv. Results Of 501 individuals surveyed by e-mail, 119 began the survey (23.8% response rate), with 88.2% self-identifying as neurohospitalists. Most neurohospitalists (63%) are 10 years or less out of training, devoting 70% of their professional time to inpatient clinical activities while also performing administrative or teaching activities. Only 38% are employed by an academic department. Call schedules are common, with 75% of neurohospitalists participating in a hospital or emergency call schedule, while 55% provide telemedicine services. The majority (97%) of neurohospitalists primarily care for adults, most commonly treating patients with cerebrovascular disease, seizures, and delirium/encephalopathy. The majority (87%) are overall pleased with their work, but 36% report having experienced burnout. Conclusions Neurohospitalists are a diverse group of neurologists primarily practicing in the inpatient setting while performing a variety of additional activities. They provide a wide array of clinical expertise for acute neurological diseases and neurological emergencies that require hospitalization, including stroke, seizure, and encephalopathy. Neurohospitalists in general are very pleased with their work, while burnout, as in neurology and other areas of medicine, remains a concern.
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Affiliation(s)
- John C Probasco
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Greene
- Emory University School of Medicine, Atlanta, GA, USA
| | - Amy Harrison
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Sandeep Khot
- University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Jana Wold
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - S Andrew Josephson
- San Francisco School of Medicine, University of California, San Francisco, CA, USA
| | - David Likosky
- Evergreen Hospital Medical Center, Kirkland, WA, USA
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Greene JG. Collaborative Comanagement Between Neurohospitalists and Internal Medicine Hospitalists Decreases Provider Costs and Enhances Satisfaction With Neurology Care at an Academic Medical Center. Neurohospitalist 2018; 8:74-81. [PMID: 29623157 DOI: 10.1177/1941874417735173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose The majority of academic medical centers are moving to a neurohospitalist model of care for hospital neurology coverage. Potential benefits over a more traditional academic model of patient care include greater expertise in acute neurologic disease, increased efficiency, and improved availability to patients, providers, and learners. Despite these perceived advantages, switching to a neurohospitalist model can come at substantial financial cost, so finding ways to maximize the positive impact of a limited number of neurohospitalists is very important to the future health of academic neurology departments. Over the past 7 years, we have implemented a model for inpatient neurological care based on an intimate collaborative relationship between the neurology and hospital medicine services at our main academic hospital. Our goal was to optimize the value of care by decreasing cost while improving quality. Methods Cost and revenue associated with professional services was evaluated on a yearly basis. As part of ongoing quality improvement efforts, yearly surveys were administered to referring providers during the transition to a collaborative care model in which NHs and medicine hospitalists comanage neurology inpatients. Results Net operating loss was dramatically decreased upon transition to the new care model. Concomitantly, there was a robust positive impact on perception of overall quality, timeliness, and communication skills of neurology services. Conclusions Collaborative comanagement is an effective strategy to improve overall satisfaction with neurology services at a tertiary academic medical center while maintaining financial viability.
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Affiliation(s)
- James G Greene
- Department of Neurology, Emory University, Atlanta, GA, USA
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Miller EC, Blum C, Rostanski SK. Developing a Stroke Center. Stroke 2017; 48:e155-e156. [PMID: 28611086 DOI: 10.1161/strokeaha.117.017745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Eliza C Miller
- From the Department of Neurology, Columbia University Medical Center, New York, NY (E.C.M.); Department of Neurology, Brown University, Miriam Hospital, Providence, RI (C.B.); Department of Neurology, New York University School of Medicine, NY (S.K.R.); and Department of Neurology, Bellevue Hospital Center, New York, NY (S.K.R.).
| | - Christina Blum
- From the Department of Neurology, Columbia University Medical Center, New York, NY (E.C.M.); Department of Neurology, Brown University, Miriam Hospital, Providence, RI (C.B.); Department of Neurology, New York University School of Medicine, NY (S.K.R.); and Department of Neurology, Bellevue Hospital Center, New York, NY (S.K.R.)
| | - Sara K Rostanski
- From the Department of Neurology, Columbia University Medical Center, New York, NY (E.C.M.); Department of Neurology, Brown University, Miriam Hospital, Providence, RI (C.B.); Department of Neurology, New York University School of Medicine, NY (S.K.R.); and Department of Neurology, Bellevue Hospital Center, New York, NY (S.K.R.)
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Klein JP. The academic neurohospitalist: Building a successful career and practice. Ann Neurol 2015; 78:515-9. [PMID: 26179680 DOI: 10.1002/ana.24483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 07/03/2015] [Accepted: 07/12/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Joshua P Klein
- Division of Hospital Neurology, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Velez-Ruiz N, Khan J, Greene JG. Defining the role of the academic neurohospitalist in residency education. Neurohospitalist 2014; 4:127-32. [PMID: 24982716 DOI: 10.1177/1941874414530722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We sought to better understand the potential impact of the burgeoning neurohospitalist model of inpatient care on education of neurology residents and to better define possible roles for "neurohospitalists" in residency education. METHOD We designed a brief qualitative open-ended survey directed toward academic leaders in neurology and distributed it by e-mail to every academic neurology department in the United States and Canada. RESULTS Of 83 respondents, 36 (43%) had an active neurohospitalist program and only 10% felt certain they would not have 1 within the next 5 years. All respondents expected to have residents continue to be involved with inpatient care. The main perceived advantage for resident education associated with neurohospitalists was inpatient care expertise, and the main expected disadvantage was decreased exposure to subspecialty attendings. The majority anticipated positive impact on all Accreditation Council for Graduate Medical Education core competencies predominantly based on neurohospitalists' expertise in the inpatient setting. CONCLUSION The majority of academic neurology departments are expected to have a neurohospitalist program within the next 5 years. There are several perceived advantages and disadvantages to such a program for education of neurology residents. In general, the impact of these programs is expected to improve resident education. Regardless of expectations, neurohospitalists will likely play a prominent role in the education of the next generation of neurologists.
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Affiliation(s)
- Naymee Velez-Ruiz
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jaffar Khan
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - James G Greene
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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George BP, Probasco JC, Dorsey ER, Venkatesan A. Impact of 2011 resident duty hour requirements on neurology residency programs and departments. Neurohospitalist 2014; 4:119-26. [PMID: 24982715 DOI: 10.1177/1941874413518640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In 2011, the Accreditation Council on Graduate Medical Education (ACGME) redefined resident duty hour requirements by reducing in-hospital duty hour requirements for residents in an effort to improve patient care, resident well-being, and resident education. We sought to determine the cost of adoption based on changes made by neurology residency programs and departments due to these requirements. METHODS We surveyed department chairs or residency program directors at 123 ACGME-accredited US adult neurology training programs on programmatic changes and resident expansion, hiring practices, and development of new computer-based resources in direct response to the 2011 ACGME duty hour requirements. Using data from publicly available resources, we estimated respondents' financial cost of adoption. RESULTS In all, 63 responded (51% response rate); 76% were program directors. The most common changes implemented by programs were adding night float systems (n = 31; 49%) and increasing faculty responsibility (n = 26; 41%). In direct response to the requirements, 21 programs applied to ACGME for 40 additional residents, 29 of which were fully covered by institutional funds. In direct response to the requirements, nearly half of the departments (n = 26) hired individuals for a total of 80 hires (or 64 full-time equivalents), most commonly mid-level practitioners. The total estimated cost to responding departments was US $12.7 million or US $201,000 per department annually. When projecting expenses of planned changes for the following year, costs increased to US $360,000 per department, with 5-year costs exceeding US $1 million. CONCLUSIONS The most recent restriction on resident duty hours comes at substantial cost to neurology departments and residency programs.
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Affiliation(s)
- Benjamin P George
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - John C Probasco
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Arun Venkatesan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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