To determine the effect of a neurohospitalist-based service on quality improvement metrics for inpatient neurology admissions compared to a non-neurohospitalist service.

Neurohospitalists may improve inpatient cost and length-of-stay (LOS) when compared to non-neurohospitalists. However, there exists conflicting evidence surrounding this topic. The purpose of this study was to compare LOS, cost of care, and 30-day readmissions before and after implementation of a neurohospitalist program at our institution.

We conducted a retrospective cohort study including all inpatients treated by our neurology providers before and after the implementation of a neurohospitalist program. Patient demographics and outcomes, including LOS, cost-of-care, and 30-day readmission were compared between the pre-neurohospitalist period (10/2016-06/2019) and the neurohospitalist period (NHP) (07/2019-12/2020) using multivariable regression.

Of the 10,194 patients admitted during the study period, 1,672 were admitted to a neurology service. There was no difference in LOS between the two periods (median 6d [IQR 3-11] vs. 6d [IQR 3-12], p=0.97), however, after adjustment for contributors to LOS, there was a significant reduction in hospital stay during the neurohospitalist period (β =-0.046, 95%CI -0.085- -0.006, p=0.03). Cost was significantly higher during the NHP in unadjusted (β 0.13, 95%CI 0.09-0.17, p<0.01) and fully adjusted (β 0.13, 95%CI 0.09-0.17, p<0.01) linear regression. In that model, admission to the neurology service was associated with significantly lower costs (β -0.51, 95%CI -0.57- -0.44, p<0.01) while admission to an intensive care unit (β 0.59, 95%CI 0.53-0.64, p<0.01) and transfer from an outside institution (β 0.19, 95%CI 0.14-0.24, p<0.01) were associated with greater costs. Readmission rates were no different between periods, after adjustment (p=0.60).

Following the implementation of a neurohospitalist program, LOS was significantly decreased among neurology inpatients, while cost increased. Admission to a neurology service versus a neurology consultation was associated with reduced costs, presumably related to medical complexity associated with patients requiring subspecialty consultation.