Aneurysmal Subarachnoid Hemorrhage Mortality After Implementation of Nocturnist Advanced Practice Provider Coverage

Authors

Diane C. McLaughlin, Questions or comments about this article may be directed to Diane C. McLaughlin, DNP AGACNP-BC CCRN, at mclaughlin.diane@mayo.edu. She is Nurse Practitioner, Department of Critical Care, Mayo Clinic, Jacksonville, FL. Margaret M. Margretta, MSN FNP-BC, is Nurse Practitioner, Department of Transplant Hepatology, Mayo Clinic, Jacksonville, FL. William D. Freeman, MD, is Chair of Neurocritical Care, Mayo Clinic, Jacksonville, FL.
Margaret M. Margretta
William D. Freeman

Document Type

Article

Abstract

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.

Medical Subject Headings

Advanced Practice Nursing (methods); Critical Care; Female; Hospital Mortality; Humans; Intensive Care Units; Intracranial Aneurysm (mortality); Male; Middle Aged; Neurology; Retrospective Studies; Subarachnoid Hemorrhage (mortality)

Publication Date

4-1-2018

Publication Title

The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses

E-ISSN

1945-2810

Volume

50

Issue

2

First Page

102

Last Page

104

PubMed ID

29521734

Digital Object Identifier (DOI)

10.1097/JNN.0000000000000352

Recommended Citation

McLaughlin, Diane C.; Margretta, Margaret M.; and Freeman, William D., "Aneurysmal Subarachnoid Hemorrhage Mortality After Implementation of Nocturnist Advanced Practice Provider Coverage" (2018). Neurology. 1985.
https://scholar.barrowneuro.org/neurology/1985