Economic Benefits of Nurse-Led Mobilization After Cranial Tumor Surgery
Overview
Implementation of the nurse-driven NERVS protocol for early post-operative mobilization in cranial tumor surgery patients significantly reduces hospital length of stay and overall hospital billing costs compared to traditional care pathways. This protocol emphasizes early mobilization, pain management, and patient education, demonstrating improved resource utilization without increasing complications.
Background
Post-operative recovery following cranial tumor surgery is often complicated by pain, reduced mobility, and prolonged hospital stays, which increase the risk of complications and healthcare costs. Enhanced Recovery After Surgery (ERAS) protocols have improved outcomes in various surgical fields but are less established in cranial neurosurgery, particularly regarding early mobilization. Physical and occupational therapy services, traditionally responsible for mobilization, face increasing demand and shortages, leading to delays in patient discharge. The NERVS protocol was developed to address these challenges by enabling nurse-led early mobilization and comprehensive post-operative care.
Data Highlights
Outcome
NERVS Group
Non-NERVS Group
p-value
Total Hospital Length of Stay (days)
Reduced (exact values not provided)
Longer
<0.05
Total Post-ICU Length of Stay (days)
Reduced
Longer
<0.05
Total Hospital Billing
Lower
Higher
<0.05
Total Professional Billing
Lower
Higher
<0.05
Post-operative Pain Scores
No significant difference
No significant difference
>0.05
Analgesic Dosing
No significant difference
No significant difference
>0.05
Key Findings
The NERVS protocol significantly reduces total hospital and post-ICU length of stay compared to non-NERVS care.
Hospital and professional billing costs are significantly lower in patients managed with the NERVS protocol.
Early mobilization led by nursing staff is feasible and safe in elective cranial tumor resection patients without neurological deficits.
Post-operative pain scores and analgesic requirements do not differ significantly between NERVS and non-NERVS groups, indicating effective pain management.
The protocol includes structured goals for mobilization starting within 4 hours post-surgery, with progressive ambulation targets and patient education components.
Failure to meet mobilization goals results in transition to traditional PT/OT pathways, ensuring patient safety.
Clinical Implications
The NERVS nurse-driven mobilization protocol offers a practical approach to enhance recovery after cranial tumor surgery by reducing hospital stay and associated costs without compromising pain control or safety. Adoption of such protocols can alleviate PT/OT service demand and facilitate earlier discharge, optimizing resource utilization in neurosurgical care. Clinicians should consider integrating nurse-led mobilization strategies into post-operative care pathways for eligible patients.
Conclusion
The nurse-led NERVS protocol effectively improves economic and clinical outcomes following cranial tumor surgery by promoting early mobilization and comprehensive post-operative care. This strategy represents a valuable addition to enhanced recovery efforts in neurosurgery.
References
Institutional Study on NERVS Protocol Implementation
Enhanced Recovery After Surgery (ERAS) Literature Reviews
by David Zarrin, Shivani Baisiwala, Jonah Im, Keshav Goel, Myungjun Ko, Sonia Wang, Humza Zubair, Alexander Valenzuela, Tristan Bennett, Dupre Orr, Won Kim
