Effect of neurosurgical high observation beds (HOBs) on service provision: a single-centre experience and cost analysis

Abstract

Objective To evaluate the effect of level 1, high observation beds (HOBs) compared with high dependency unit (HDU) and neurosurgical intensive care unit (NICU) admission on service provision, such as cancelled operations, and healthcare costs.Methods A retrospective, observational, single-centre cross-sectional study at a single, large UK neurosurgical centre. All adult patients admitted to neurosurgical HOBs between December 2021 and July 2022 were included. The list of cancelled procedures was collected from 2019 to 2022. To evaluate the impact of admission of eligible patients to HOBs, the total bed days, cost per bed day, number of admissions and cost per admission were obtained for all clinical areas the financial years 2019/2020 and 2021/2022.Results 307 patients were included in the study: 59.7% of HOBs admissions were elective and 37.7% were acute; admissions were for cranial procedures or conservative treatment (64.8%), spinal (32.6%) or other (2.6%). Following admission, 73.3% of patients were stepped down to the ward prior to discharge home. Only seven patients required escalation to level-2 or level-3 care. Overall, 97% of all HOBs patients were discharged home at the end of hospital stay. Occupancy rate was 90.4%.The cost of bed day increased from ward, level 0 (£384), then level 1 (£376), to level 2 (£787–1211) and to level 3 (£1628). From 2019 to 2021, 558 operations had been cancelled, and 140 (37.8%) of 370 were estimated to have been potentially avoided by HOBs admissions due to conflict of scheduling, ward bed capacity and critical care bed capacity. In addition, a minimum total expenditure due to cancelled operations was estimated at £22 923.50 yearly on average.Conclusion This study recognises HOBs growing role in the management of acutely unwell patients in ward-based environments. While recognising the associated challenges, this study highlighted the potential in reducing healthcare costs. Further studies should evaluate the impact and limitations of HOBs on patients’ recovery and outcomes, compared to HDU and NICU.