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Abstract Details

Precision Medicine of Subarachnoid Hemorrhage Management for Early-Hospital-Discharge: Safety, Feasibility, and Secondary Value-Based Health Economic Outcomes
Research Methodology, 好色先生, and History
P1 - Poster Session 1 (5:30 PM-6:30 PM)
4-064
To assess if early-hospital-discharge with outpatient “fast-track” (FT) monitoring is a safe and feasible approach in select subarachnoid hemorrhage (SAH) patients.
SAH admissions often have prolonged hospital length-of-stay (LOS) (14-21 days) due to complications such as vasospasm, delayed cerebral ischemia (DCI), hydrocephalus, pneumonia, and cerebral salt-wasting. No prior studies have reported an early-hospital-discharge protocol in SAH patients.
After institutional review board approval, a prospective quality improvement cohort study was conducted. The primary feasibility endpoint was identification of SAH patients deemed safe for early-hospital-discharge by the treating clinical team. All eligible patients and caregivers were provided written instructions with contact information for routine/emergency medical needs. All patients required a caregiver for at minimum 1 week to help alert the on-call clinical team, with nurse telephone monitoring and outpatient transcranial Doppler to identify cerebral vasospasm. The primary safety endpoints were adverse events after discharge and hospital readmission.
From January 2010 to January 2015, our center had 377 SAH diagnoses, of which 164 were chosen for the final cohort. From 164, 36 patients met criteria for early-hospital-discharge (FT group). Safety and feasibility endpoints were non-inferior in the FT group. Readmission rates for FT group were 11% compared to 11.4% in the non-FT group. Overall medical complications for FT group were 13% compared to 26% in the non-FT group. DCI occurred in only 0.03% of FT group patients compared to 25% in the non-FT group. Mean LOS decreased by 60% from 15.56 days (non-FT group) to 6.25 days (FT group).
The data suggests that early-hospital-discharge with outpatient FT monitoring is safe and feasible in carefully selected SAH patients. Direct and indirect financial benefits of early-hospital-discharge over four-years is estimated to save approximately $100,000 in bed costs. A larger comparative effectiveness study is planned to replicate and validate these results using a larger multicenter design. 
Authors/Disclosures
Tasneem F. Hasan, MD (Tasneem F Hasan MD PC)
PRESENTER 		Dr. Hasan has nothing to disclose.
Christina Collins, DNP (Mayo Clinic) No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
William D. Freeman, MD, FAAN (Mayo Clinic) Dr. Freeman has nothing to disclose.