Significant reduction in hospitalization length of stay by integrating echocardiographic workup inside the acute neurovascular care unit

Background Echocardiographic evaluation is recommended in the acute phase of stroke mainly for etiological and therapeutic purpose but also for cardiovascular comorbidities assessment. Echocardiography (TTE) is known as an easy accessible tool. However facing an increasing incidence in strokes and TTE accessibility concerns due to organizational strains, TTE completion during hospital stay is often delayed and about to increase patient's length of stay (LOS). Purpose To evaluate the impact of the integration of TTE inside the acute neurovascular care unit (ANCU) for patients with an acute stroke on: – the percentage of in-hospital TTE; – the admission to in-hospital TTE delay; – the global LOS and specific LOS for patients having a TTE within the hospital stay. Methods We retrospectively compared period A, after TTE integration lasting from Oct 2017 to Feb 2018 to period B, before TTE integration lasting from Oct 2016 to Feb 2017. LOS was compared between periods and independent covariates were explored with TTE delay. Results Table 1 summarizes main characteristics. Proportions of total and in-hospital TTE completion were higher in period A but global LOS was not different. However TTE delay and LOS for the subgroup of patients having a TTE within the hospital stay were significantly lower in period A. Linear regression identified comorbidity index and TTE delay as independent factors influencing LOS in this subgroup. Increasing comorbidity index by 1000 and TTE delay by 1 day increased LOS by 1.2 days for both. Conclusion TTE integration in the ANCU improves quality of care and shortens TTE completion's delay as well as LOS. This calls for an early integration of cardiology in stroke care.