Improvement in Quality Metrics Outcomes and Patient and Family Satisfaction in a Neurosciences Intensive Care Unit after Creation of a Dedicated Neurocritical Care Team.

INTRODUCTION: Dedicated neurointensivists have been shown to improve outcome measurements in the neurosciences intensive care unit (NSICU). Quality outcome data in relation to patient and family satisfaction is lacking. This study evaluated the impact of newly appointed neurointensivists and creation of a neurocritical care team on quality outcome measures including patient satisfaction in a NSICU. METHODS: This is a retrospective study of data over 36 months from a 14-bed NSICU evaluating quality outcome measures and anonymous patient satisfaction questionnaires before and after neurointensivists appointment. RESULTS: After appointment of neurointensivists, patient acuity of the NSICU increased by 33.4% while LOS decreased by 3.5%. There was a decrease in neurosciences mortality (35.8%), catheter-associated urinary tract infection (50%), central line associated bloodstream infection (100%), and ventilator-associated pneumonia (50%). During the same time, patient satisfaction increased by 28.3% on physicians/nurses consistency (p = 0.025), by 69.5% in confidence/trust in physicians (p < 0.0001), by 78.3% on physicians treated me with courtesy/respect (p < 0.0001), and by 46.4% on physicians' attentiveness (p < 0.0001). Ultimately, patients recommending the hospital to others increased by 67.5% (p < 0.0001). CONCLUSION: Dedicated neurointensivists and the subsequent development of a neurocritical care team positively impacted quality outcome metrics, particularly significantly improving patient satisfaction.

Successful Resuscitation: Novel Partnership between Paramedics and U.S. Coast Guard.

In this article, we present a notable case that illustrates a novel partnership between a United States Coast Guard small boat station and a civilian paramedic response unit. Patients who experience medical emergencies in remote environments are at particularly high risk for morbidity and mortality. For the most serious conditions, delayed contact with Advanced Life Support (ALS) has grave results. Typically, these circumstances involve small groups of individuals and cannot be easily predicted. The waters off the coasts of Maui, Hawaii, however, host millions of residents and visitors annually, with activities including swimming, snorkeling, diving, parasailing, and other types of ocean recreation. As a result, medical and rescue emergencies are not uncommon, many with poor outcomes. Prior to October of 2013, a Coast Guard response boat crew with limited medical training and equipment responded to most off shore cases. Since October 2013, a paramedic from Maui County EMS co-responds aboard the Coast Guard boat with a full complement of ALS equipment. This partnership has resulted in some significant improvements in patient outcome, and strengthened a collaborative emergency services system. The experience has also indicated the need for continued improvement in early activation and communication, as well as reinforcing the importance of primary prevention.